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Sample records for underwent cesarean section

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

    Science.gov (United States)

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

    2016-09-15

    Hematocrits were measured before each of 406 cesarean sections performed on 324 bitches at term and again after crystalloid fluid therapy administered at 35 mL/kg over 1½-2 hours starting from induction. The mean hematocrit was 44.2% (95% confidence interval [CI] 43.8%-44.6%) before cesarean section and 37.8% (95% CI 37.3%-38.2%) after cesarean section and fluid therapy, with a mean decrease of 6.4% points (95% CI 6.1%-6.7%) over all 406 cesarean sections. These results provide the clinician with clear guidelines of the normal expected ranges of hematocrits in bitches before and after cesarean section. Results of this study show that bitches have hematocrits at term that are at the lower end of the normal reference ranges for nonpregnant dogs and that there is no true anemia of pregnancy. It is therefore suggested that if late term bitches present with anemia, other causes besides pregnancy should be considered. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Cesarean Section

    Science.gov (United States)

    A Cesarean section (C-section) is surgery to deliver a baby. The baby is taken out through the mother's ... are able to have a vaginal birth after cesarean (VBAC). NIH: National Institute of Child Health and ...

  3. Cesarean section

    Science.gov (United States)

    ... within a few days, barring complications like wound infections. One concern that many women have is whether they'll be able to have a normal delivery after having a cesarean. The answer depends on what the reasons were ...

  4. Birth after cesarean section

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    Velem?nsk?, Milo?; Velem?nsk?, Milo?; Piskorzov?, Martina; Ba?kov?, Martina; T?thov?, Val?rie; Str?nsk?, Pravoslav

    2011-01-01

    Summary Background The number of incoming expectant women who have previously experienced cesarean section has increased. This work sought to find the frequency and connections between vaginal deliveries, cesarean sections, and iterative cesarean sections from 2004 to 2008. Material/Methods In all, 828 women with previous cesarean sections were included. From this group, 8282 vaginal deliveries were performed. During these years, 828 women had a history of the cesarean section; in these women...

  5. Cesarean Section - Multiple Languages

    Science.gov (United States)

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

  6. Delivery by Cesarean Section

    Science.gov (United States)

    ... Stages Listen Español Text Size Email Print Share Delivery by Cesarean Section Page Content Article Body More ... mother has had a previous baby by Cesarean delivery The obstetrician feels that the baby’s health might ...

  7. Cesarean Sections

    Science.gov (United States)

    ... time. They'll get smaller and become a natural skin color in the weeks and months after delivery. And because incisions are often made in the "bikini" area, many C-section scars aren't even noticeable. What If I Don't Feel Better? Call your health care provider if you have: a fever signs of ...

  8. [Cesarean section through history].

    Science.gov (United States)

    Rabinerson, David; Ashwal, Eran; Gabbay-Benziv, Rinat

    2014-11-01

    According to historic documents, delivery by abdominal and uterine incision was already known to mankind at the beginning of the second millennium BC. This delivery method was eventually referred to as "Cesarean Section" because it was wrongfully attributed to the way by which Julius Caesar was born. The indications for cesarean sections performed in ancient cultures and to the end of the medieval period were mainly kings law, that mandated burial of the fetus separately from his mother, legal rights regarding inheritance of the father or religious motives mandating baptism of the newborn in order to ensure him eternal life in heaven. As from the second half of the 19th century AD, and with improvement in surgical techniques, as well as in the perioperative environment (asepsis, antibiotics, anaesthesia, blood transfusion, etc.), the obstetric outcome of cesarean sections was dramaticay improved, both in terms of maternal, as well as fetal, outcome. Hence, it became very prevalent throughout the world. The emergence of medico-legal medicine and medical ethics issues, have further contributed to the use of cesarean sections as the ultimate solution of every unusual delivery.

  9. Cesarean section by maternal request

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    RAPHAEL CÂMARA

    Full Text Available ABSTRACT Cesarean section by maternal request is the one performed on a pregnant woman without medical indication and without contraindication to vaginal delivery. There is great controversy over requested cesarean section. Potential risks include complications in subsequent pregnancies, such as uterine rupture, placenta previa and accreta. Potential benefits of requested cesareans include a lower risk of postpartum hemorrhage in the first cesarean and fewer surgical complications compared with vaginal delivery. Cesarean section by request should never be performed before 39 weeks.

  10. CT of the pelvis after cesarean section

    International Nuclear Information System (INIS)

    Twickler, D.; Setiawan, H.; Harrell, R.; Brown, C.E.L.

    1989-01-01

    Febrile morbidity following cesarean section is often evaluated with CT, although the CT appearance of the normal uterus has not been evaluated. This study was undertaken to learn the normal uterine appearance after cesarean section. To date, 15 women who also underwent bilateral tubal ligation have been studied. Six had a vertical uterine incision; nine had a low transverse incision. Contrast-enhanced pelvic CT was performed 1--5 days after surgery. All women were asymptomatic, with a normal postpartum course

  11. Scar Endometriosis Following Cesarean Section

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    Rüya Deveer

    2012-04-01

    CONCLUSION: Abdominal wall endometriosis frequently presents with cyclical pain during menstruation which is localised to a palpable mass in the abdominal wall especially in those who have had previous cesarean section. Complete surgical excision is curative.

  12. Placental complications after a previous cesarean section

    OpenAIRE

    Milošević Jelena; Lilić Vekoslav; Tasić Marija; Radović-Janošević Dragana; Stefanović Milan; Antić Vladimir

    2009-01-01

    Introduction The incidence of cesarean section has been rising in the past 50 years. With the increased number of cesarean sections, the number of pregnancies with the previous cesarean section rises as well. The aim of this study was to establish the influence of the previous cesarean section on the development of placental complications: placenta previa, placental abruption and placenta accreta, as well as to determine the influence of the number of previous cesarean sections on the complic...

  13. Evolution & the Cesarean Section Rate

    Science.gov (United States)

    Walsh, Joseph A.

    2008-01-01

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

  14. Is it safe to have multiple repeat cesarean sections? A high volume tertiary care center experience.

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    Biler, Alper; Ekin, Atalay; Ozcan, Aykut; Inan, Abdurrahman Hamdi; Vural, Tayfun; Toz, Emrah

    2017-01-01

    To compare the obstetric outcomes of cesarean section in women who had a history of four or more previous cesarean sections with those who had a history of two or three previous cesarean sections. Total 1318 women who underwent repeat cesarean section between January 2013 and January 2016 were retrospectively reviewed. Of these, 244 (18.5%) had previously had four or more cesarean sections (multiple repeat cesarean section group) and 1074 (81.5%) had previously had two or three cesarean sections (control group). Demographic characteristics and obstetric outcomes were compared using the Independent t and chi-square tests. The adhesion rate (p cesarean section group compared to control group. Although multiple repeat cesarean section are asscociated with adhesion occurrence, higher number of blood transfusion, increased operation time and length of hospital stay, there is no remarkable difference in serious morbidity associated with multiple repeat cesarean section.

  15. Vacuum-assisted cesarean section

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    McQuivey RW

    2017-03-01

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

  16. Risk factors for relaparotomy after cesarean section.

    Science.gov (United States)

    Kessous, Roy; Danor, Daniela; Weintraub, Y Adi; Wiznitzer, Arnon; Sergienko, Ruslan; Ohel, Iris; Sheiner, Eyal

    2012-11-01

    To investigate risk factors for relaparotomy after cesarean section (CS). A retrospective case-control study comparing all CS that were complicated with relaparotomy to cesarean deliveries without this complication. Relaparotomy complicated 0.23% (n=80) of CS during the study period (n=34,389). Independent risk factors for relaparotomy following CS from a multivariable logistic regression model were post partum hemorrhage, cervical tears, placenta previa, uterine rupture, placental abruption, severe preeclampsia and previous CS. Most women (51.2%) underwent relaparotomy during the first 24 h after CS. The leading causes for relaparotomy was bleeding (70%) and burst abdomen (8.8%). Hysterectomy was performed in 31.3% of the patients. Risk factors for relaparotomy after CS are previous CS, severe preeclampsia, placenta previa, uterine rupture, placental abruption, cervical tear and PPH. Experienced obstetricians should be involved in such cases and the possibility for complications including relaparotomy should be emphasized.

  17. [Placental complications after a previous cesarean section].

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    Milosević, Jelena; Lilić, Vekoslav; Tasić, Marija; Radović-Janosević, Dragana; Stefanović, Milan; Antić, Vladimir

    2009-01-01

    The incidence of cesarean section has been rising in the past 50 years. With the increased number of cesarean sections, the number of pregnancies with the previous cesarean section rises as well. The aim of this study was to establish the influence of the previous cesarean section on the development of placental complications: placenta previa, placental abruption and placenta accreta, as well as to determine the influence of the number of previous cesarean sections on the complication development. The research was conducted at the Clinic of Gynecology and Obstetrics in Nis covering 10-year-period (from 1995 to 2005) with 32358 deliveries, 1280 deliveries after a previous cesarean section, 131 cases of placenta previa and 118 cases of placental abruption. The experimental groups was presented by the cases of placenta previa or placental abruption with prior cesarean section in obstetrics history, opposite to the control group having the same conditions but without a cesarean section in medical history. The incidence of placenta previa in the control group was 0.33%, opposite to the 1.86% incidence after one cesarean section (pcesarean sections and as high as 14.28% after three cesarean sections in obstetric history. Placental abruption was recorded as placental complication in 0.33% pregnancies in the control group, while its incidence was 1.02% after one cesarean section (pcesarean sections. The difference in the incidence of intrapartal hysterectomy between the group with prior cesarean section (0.86%) and without it (0.006%) shows a high statistical significance (pcesarean section is an important risk factor for the development of placental complications.

  18. Stress Prolongs Wound Healing Post Cesarean Section

    OpenAIRE

    Yusuf, Ah; Armini, Ni Ketut Alit; Nurfianti, Arina

    2007-01-01

    Introduction: Decision for cesarean section may lead to the stress for women in delivery. Stress response requires longer recovery time in post cesarean section patients. Most of patients who experience stress before and after surgical is associated with wound healing delay. When this condition continues, the wound will have a higher risk of infection. The objective of this study was to analyze correlation between stress and wound healing phase in post cesarean section patients. Method: A cro...

  19. STRESS PROLONGS WOUND HEALING POST CESAREAN SECTION

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    Ah. Yusuf

    2017-07-01

    Full Text Available Introduction: Decision for cesarean section may lead to the stress for women in delivery. Stress response requires longer recovery time in post cesarean section patients. Most of patients who experience stress before and after surgical is associated with wound healing delay. When this condition continues, the wound will have a higher risk of infection. The objective of this study was to analyze correlation between stress and wound healing phase in post cesarean section patients. Method: A cross sectional design was used in this study. The population were women with cesarean section, both elective or emergency, in Delivery Room I RSU Dr. Soetomo Surabaya. Samples were recruited by using purposive sampling, with 28 samples who met to the inclusion criterias. The observed variables were stress and wound healing phase in post cesarean section patient. Stress data were collected by interview and wound healing measurement done by observation on the 3rd day post cesarean section. Result: The result showed that women with stress experience wound healing delay. The characteristic of wound healing delay was prolonged on inflammation phase, nevertheless there was presence of granulation tissue. Spearman’s rho correlation showed that correlation value r=0.675 with p=0.000. Discussion: It can be concluded that there was strong significant correlation between stress and wound healing phase in post cesarean section patients. It is important to give this information to the patients with cesarean section in order to prevent stress and delay in wound healing phase.

  20. Educational strategies in performing cesarean section

    DEFF Research Database (Denmark)

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

    2012-01-01

    during surgical training. The Danish, Swedish and British Obstetric and Gynecological Societies' guidelines on cesarean section were reviewed regarding cesarean section surgical technique. Placental removal by traction on the umbilical cord is recommended uniformly, however, the Danish guidelines...... and surgical technique as well as basic anatomy, should be verified before entering a training program for cesarean section. Such a training program for technical and non-technical skills in cesarean section should include theoretical instruction, video tutorials, practical experience and direct supervision....... Development of a specific OSATS for cesarean section is recommended. Training must be individually structured accommodating the differences in trainees' competencies. Before clinical training in the operating room begins, all trainees must attain standardized cognitive and technical skills. © 2012 The Authors...

  1. 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)

  2. Vaginal delivery after one cesarean section

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    Bianca Totta Patrício

    2012-11-01

    Full Text Available ABSTRACT Objective: to identify the validity of trial of labor in women with second pregnancy and previous cesarean section, to observe vaginal deliverance and probable maternal and perinatal complications. Methods: prospective cohort study of labors (03/2010 - 03/2011. The dependent variables analyzed: vaginal delivery or cesarean section, puerperal and perinatal results complications. The control variables were: epidemiological data, previous maternal and perinatal history, maternal and fetal wellness, labor induction, weekly day and hour of labor, moment of information and birth justification to the patient. The statistical comparison used the chi-squared test with 5% significance and the program Statistical Package for Social Sciences. Results: significance in steady union and married women for cesareans sections, and single in vaginal births (p = 0.004; complete membranes were significant in cesareans sections and rupture of them to vaginal deliveries (p = 0,.001. There was a predominance of cesareans sections during 12:01 - 24:01 hours, and vaginal births from 00:01 - 6:00 hours (p = 0.036. There were no significant events in maternal and fetal complications. Newborns of c-sections were significantly heavier (p = 0.011; extra-uterine vital conditions of 1 and 5 minutes presented no difference between cesarean sections and vaginal births. Conclusion: the trial of labor in 80 patients with second pregnancy and one previous cesarean section avoided the second cesarean section in 42,5% in this patients. The results confirm that trial of labor should be stimulated to labor patients with second pregnancy and one previous cesarean section.

  3. [Ogilvie syndrome after Cesarean section].

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    Schjoldager, B T; Sørensen, J L; Svaerke, T; Berthelsen, J G

    2001-05-28

    Ogilvie's syndrome, acute pseudo-obstruction of the colon, can lead to perforation of the caecum and death. The syndrome is not well known and diagnosis can be difficult to make in time. We analysed seven cases of Ogilvie's syndrome with the aim of improving diagnostics. All had prolonged labour before cesarean section, which was complicated by bleeding. All were treated with syntocinon, a hormone that may influence gastrointestinal motility. All patients developed abdominal meteorism within a few days of operation, which increased despite the passing of flatus and stool. Five cases resulted in caecum perforation before the correct diagnosis and treatment were made. Perforation occurred on days 3-4, day 5, or probably days 8-10 after the operation. One of these patients, who suffered from severe adipositas, died. It is very important to make an early diagnosis, as the condition can progress quickly. Diagnosis should be made on the history, clinical assessment, and abdominal X-ray. Intermittent flatus and stool are characteristic of this truly non-obstructive condition and should not therefore delay a diagnostic X-ray.

  4. Cesarean section and hernia repair: simultaneous approach.

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    Gabriele, Raimondo; Conte, Marco; Izzo, Luciano; Basso, Luigi

    2010-10-01

    Hernias of the abdominal wall occurring during pregnancy are usually treated a few weeks after delivery. The aim of this study was to retrospectively evaluate the clinical outcome of inguinal or umbilical hernioplasty performed at the time of the cesarean section, and to compare the outcome of this group with a control population, who received a cesarean section alone. We reviewed 28 women who developed an inguinal or umbilical hernia during pregnancy from January 1, 2000 to December 31, 2007 and who received a combined cesarean section and hernia repair, and we compared this group with 100 women (controls) who only received a cesarean section. In the group of women who received a combined cesarean section and inguinal or umbilical hernia repair, median age was 23.8 years and hospital stay ranged from 3 to 5 days (versus 3-4 days for cesarean sections alone). The time employed for the combined surgical procedure was of 50 ± 7 min and 70 ± 4 min, respectively, for umbilical and inguinal hernia (versus 37.4 ± 12.6 min for cesarean sections alone). No complication was recorded during the perinatal and follow-up periods, and no recurrences were observed. Our analysis suggests that cesarean section and hernia repair, performed in one session, avoids need for readmission to hospital, is safe, effective, and well accepted. It neither increases the complication rate nor prolongs the hospital stay, with clear advantages for both the patients and the hospital budget. © 2010 The Authors. Journal of Obstetrics and Gynaecology Research © 2010 Japan Society of Obstetrics and Gynecology.

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

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    Farideh Keypour

    2013-07-01

    Full Text Available Background: Cerebral venous thrombosis (CVT is uncommon after cesarean section. Although it can be a leading cause of maternal mortality. CVT may occur during pregnancy because of hypercoagulable states such as preeclampsia, thrombophilias, antiphospholipid antibody syndrome and sepsis.Case presentation: A 31 years old woman G2 Ab1 at 37 weeks gestational age with  premature rupture of membrane underwent cesarean section because breech presentation and preeclampsia. Spinal anesthesia was done for emergent cesarean section. On the second day after cesarean section, she developed headache, vomiting, focal neurologic deficits, paresthesia, blurred vision. Brain magnetic resonance imaging (MRI showed thrombosis in anterior half of superior sagittal sinus. Treatment consisted of anticoagulation.  Conclusion: Thrombophilias, pregnancy-related hypertension and cesarean section are the predisposing factors for thromboembolism. Unfractionated heparin and low molecular weight heparin (LMWs are effective drugs for thromboprophylaxis. It is vital to prevent venous thrombosis to reduce mortality during both intrapartum and postpartum periods. Consideration of cerebral venous thrombosis in similar cases is recommended.

  6. Maternal and Fetal Outcome in Elective versus Emergency Cesarean Section

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    Anupama Suwal

    2013-12-01

    Results: The incidence of cesarean section was 254 (22.30% out of which emergency cesarean section accounted for 167 (65.7% and elective cesarean section for 87 (34.3%. The usual indications of emergency cesarean section were fetal distress, previous cesarean section in labour, non progress of labour and prolonged second stage of labour. The usual indications of elective cesarean section were previous cesarean section, breech, cephalopelvic disproportion and cesarean section on demand. There was found to be no significant difference in age, period of gestation, blood loss and blood transfusion in emergency vs. elective cesarean section. There was significant difference seen in the length of hospital stay, fever, urinary tract infection, wound infection and low APGAR in five minutes indicating that these were more common in emergency cesarean section. Significant difference was also seen in the incidence of postpartum haemorrhage indicating that it was seen more in elective cesarean section. Conclusions: The incidence of cesarean section in Nepal Medical College Teaching Hospital is high and the overall complication rate is higher in emergency cesarean section than in elective cesarean section. Keywords: cesarean section; fetal and maternal outcome.

  7. [Factors related to hemorrhage during cesarean section].

    Science.gov (United States)

    Aujang, Enrique Rosales

    2013-05-01

    Cesarean section is the most frequent surgery done at health sector hospitals and its most frequent complications include hemorrhage. To determine if risk factors known for this complication are really a risk and to determine the reliability of the measurement of hematocrit and hemoglobin as parameters to quantify the hemorrhage. A prospective study involving 412 patients was done analyzing the following variables: age, previous cesarean section, occupation, body mass index, hours of labor, weight of the newborn, surgical time, bleeding estimated by the anesthesiologist, hemoglobin and hematocrit. By measuring hemoglobin a significant difference was obtained in favor of minor bleeding in the groups of 21 to 30 years, with normal weight and moderate obesity, with two prior cesarean sections, weight of the newborns of 3 to 4 kg, with less than two hours of labor, when the surgery took less than 50 minutes and when the bleeding was estimated at less than 500 mL. By measuring hematocrit the difference was significant in favor of more bleeding in the following groups: from 31 to 40 years, with mild obesity, without none or one cesarean section, with weight of newborns from 3 to 4 kg, with three to six hours of labor, when the cesarean section took 41 to 50 minutes and when the bleeding was estimated at less than 500 mL. There are significant differences with the measurement of hemoglobin and hematocrit among the risk factors analyzed.

  8. Cesarean sections in a birth center.

    Science.gov (United States)

    Osava, Ruth Hitomi; Silva, Flora Maria Barbosa da; Tuesta, Esteban Fernandes; Oliveira, Sonia Maria Junqueira Vasconcellos de; Amaral, Maria Clara Estanislau do

    2011-12-01

    To estimate the prevalence of cesarean sections in a birth center of a hospital and identify factors associated. Cross-sectional study including medical records of 2,441 births assisted in a birth center in the city of São Paulo, southeastern Brazil, between March and April 2005. The dependent variable (type of delivery) included vaginal delivery and cesarean section. The independent variables were grouped into four categories: demographic characteristics; current and past obstetric history; intrapartum care; and perinatal outcomes. Prevalence ratios and 95% confidence intervals (95% CI) were estimated to assess the association between type of delivery and maternal and newborn variables. Of all deliveries, 14.9% were cesarean sections. Cesarean section in the current pregnancy was associated with past cesarean sections (PR = 3.19, 95%CI: 2.64,3.84); gestational age > 40 weeks (PR = 1.32, 95%CI: 1.09;1.61); cervical dilation of up to 4 cm on admission (PR = 3.22, 95%CI: 2.31;4.50); and meconium-stained amniotic fluid (PR = 2.5, 95%CI: 2.05;3.06). Regarding newborn characteristics cesarean section was associated with birth weight >4 kg (PR = 1.86, 95%CI: 1.29;2.66). Among women with history of past cesarean sections, having had also a prior vaginal delivery was a protective factor for cesarean section in the current pregnancy (PR = 0.46, 95%CI: 0.30;0.71). Factors related to fetal conditions including fetal stress, meconium-stained amniotic fluid, breech presentation and macrosomia accounted for 47.8% (175) while those related to the mechanism of birth including arrest disorders, functional dystocia and malposition accounted for 31,3% (115) of all indications for a cesarian section [corrected]. Prevalence of c-section was consistent with World Health Organization recommendations. Increased risk of c-section was associated with prior history of c-sections, cervical dilation of at least 4 cm upon admission, gestational age > 40 weeks, meconium-stained amniotic fluid

  9. Maternal and fetal outcome in elective versus emergency cesarean section.

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    Suwal, Anupama; Shrivastava, Veena R; Giri, Amrita

    2013-01-01

    The complications of cesarean section are seen more commonly in emergency than in elective cases. The aim of this study was to find out the incidence of cesarean section in Nepal Medical College Teaching Hospital and to compare the maternal and fetal outcome in elective and emergency cesarean section. A prospective study of all the cases undergoing cesarean section in Nepal Medical College Teaching Hospital was carried out during the period of six months from Asar 2069 to Mangsir 2069. The incidence of cesarean section was 254 (22.30%) out of which emergency cesarean section accounted for 167 (65.7%) and elective cesarean section for 87 (34.3%). The usual indications of emergency cesarean section were fetal distress, previous cesarean section in labour, non progress of labour and prolonged second stage of labour. The usual indications of elective cesarean section were previous cesarean section, breech, cephalopelvic disproportion and cesarean section on demand. There was found to be no significant difference in age, period of gestation, blood loss and blood transfusion in emergency vs. elective cesarean section. There was significant difference seen in the length of hospital stay, fever, urinary tract infection, wound infection and low APGAR in five minutes indicating that these were more common in emergency cesarean section. Significant difference was also seen in the incidence of postpartum haemorrhage indicating that it was seen more in elective cesarean section. The incidence of cesarean section in Nepal Medical College Teaching Hospital is high and the overall complication rate is higher in emergency cesarean section than in elective cesarean section.

  10. Youssef’s Syndrome following Cesarean Section

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    Ozer Birge

    2015-01-01

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

  11. Cesarean section changes neonatal gut colonization.

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    Stokholm, Jakob; Thorsen, Jonathan; Chawes, Bo L; Schjørring, Susanne; Krogfelt, Karen A; Bønnelykke, Klaus; Bisgaard, Hans

    2016-09-01

    Delivery by means of cesarean section has been associated with increased risk of childhood immune-mediated diseases, suggesting a role of early bacterial colonization patterns for immune maturation. We sought to describe the influence of delivery method on gut and airway colonization patterns in the first year of life in the Copenhagen Prospective Studies on Asthma in Childhood2010 (COPSAC2010) birth cohort. Seven hundred children from the COPSAC2010 birth cohort participated in this analysis. Fecal samples were collected at age 1 week, 1 month, and 1 year, and hypopharyngeal aspirates were collected at age 1 week, 1 month, and 3 months and cultured for bacteria. Detailed information on delivery method, intrapartum antibiotics, and lifestyle factors was obtained by personal interviews. Seventy-eight percent of the children were born by means of natural delivery, 12% by means of emergency cesarean section, and 9% by means of elective cesarean section. Birth by means of cesarean section was significantly associated with colonization of the intestinal tract by Citrobacter freundii, Clostridium species, Enterobacter cloacae, Enterococcus faecalis, Klebsiella oxytoca, Klebsiella pneumoniae, and Staphylococcus aureus at age 1 week, whereas colonization by Escherichia coli was associated with natural birth. At age 1 month, these differences were less prominent, and at age 1 year, they were not apparent, which was confirmed by means of multivariate data-driven partial least squares analyses. The initial airway microbiota was unaffected by birth method. Delivery by means of cesarean section was associated with early colonization patterns of the neonatal gut but not of the airways. The differences normalized within the first year of life. We speculate that microbial derangements, as indicated in our study, can demonstrate a possible link between delivery by means of cesarean section and immune-mediated disease. Copyright © 2016 American Academy of Allergy, Asthma

  12. Cesarean section changes neonatal gut colonization

    DEFF Research Database (Denmark)

    Stokholm, Jakob; Thorsen, Jonathan; Chawes, Bo L

    2016-01-01

    -driven partial least squares analyses. The initial airway microbiota was unaffected by birth method. CONCLUSION: Delivery by means of cesarean section was associated with early colonization patterns of the neonatal gut but not of the airways. The differences normalized within the first year of life. We speculate...

  13. Ga-67 uptake post cesarean section

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

    1984-02-01

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

  14. Ga-67 uptake post cesarean section

    International Nuclear Information System (INIS)

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

    1984-01-01

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

  15. Maternal and Fetal Outcome in Elective versus Emergency Cesarean Section

    OpenAIRE

    Anupama Suwal; Veena R Shrivastava; Amrita Giri

    2013-01-01

    Introduction: The complications of cesarean section are seen more commonly in emergency than in elective cases. The aim of this study was to find out the incidence of cesarean section in Nepal Medical College Teaching Hospital and to compare the maternal and fetal outcome in elective and emergency cesarean section. Methods: A prospective study of all the cases undergoing cesarean section in Nepal Medical College Teaching Hospital was carried out during the period of six months f...

  16. Value of computed tomography pelvimetry in patients with a previous cesarean section

    International Nuclear Information System (INIS)

    Yamani, Tarik Y.; Rouzi, Abdulrahim A.

    1998-01-01

    A case-control study was conducted at the Department of Obstetrics and Gynaecology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia to determine the value of computed tomography pelivimetry in patients with a previous cesarean section. Between January 1993 and December 1995, 219 pregnant women with one previous cesarean had antenatal CT pelvimetry for assessment of the pelvis. One hundred and nineteen women did not have CT pelvimetry and served as control. Fifty-one women (51%) in the CT pelvimetry group were delivered by cesarean section. Twenty-three women (23%) underwent elective cesarean section for contracted pelvis based upon the findings of CT pelvimetry and 28 women (28%) underwent emergency cesarean section after trial of labor. In the group who did not have CT pelvimetry, 26 women (21.8%) underwent emergency cesarean section. This was a statistically significant difference (P=0.02). There were no statistically significant differences in birthweight and Apgar scores either group. There was no prenatal or maternal mortality in this study. Computed tomography pelvimetry increased the rate of cesarean delivery without any benefit in the immediate delivery outcomes. Therefore, the practice of documenting the adequacy of the pelvis by CT pelvimetry before vaginal birth after cesarean should be abandoned. (author)

  17. Factors leading to cesarean section delivery at Felegehiwot referral hospital, Northwest Ethiopia: a retrospective record review.

    Science.gov (United States)

    Abebe, Fantu Eyowas; Gebeyehu, Abebaw Worku; Kidane, Ashebir Negasi; Eyassu, Gizached Aynalem

    2016-01-20

    Cesarean section is the commonest obstetric operative procedure worldwide. When used appropriately cesarean sections can improve infant and/or maternal outcomes. However, when used inappropriately the potential harm may exceed the potential benefit of cesarean section. Appreciating the limited information in this area the current study assessed the rate and factors associated with cesarean section in Felegehiwot referral hospital, Bahir Dar, northwest Ethiopia. The study was a retrospective analysis of eligible patient records that included 2967 pregnant women who had underwent either cesarean or vaginal delivery from July 1, 2012 to June 31, 2013. The data were double entered to EPI-INFO 3.5.2 and analyzed with SPSS. Binary logistic regression model was fitted to identify independent factors associated with cesarean section. The proportion of women who underwent cesarean section in this study was 25.4%. Obstructed labor (30.7%), fetal distress (15.9%) and abnormal presentation (13.4%) were the major obstetric indications for cesarean section. The odd of undergoing cesarean section was higher among mothers in rural residence (AOR = 1.63, 95% CI: 1.21, 2.20), mothers reported to have pregnancy risk factors (AOR = 2.31, 95% CI: 1.74, 3.07) and lower among mothers in age category of 15-19 (AOR = 0.63, 95% CI: 0.43, 0.93). Obstetric factors occurring around birth, including obstructed labor and fetal distress were the main reasons leading to Cesarean Section rather than background characteristics assumed to be a risk. The results imply that there is a need for timely and accurate screening of women during obstetric care and, decision to perform cesarean section should be based on clear, compelling and well-supported justifications.

  18. Panniculectomy at the Time of Cesarean Section and Postoperative Wound Complications in Morbidly Obese Women.

    Science.gov (United States)

    Fennimore, Robin; Fabbri, Stefka; Miranda-Seijo, Pedro

    2015-01-01

    To determine whether a modified abdominal panniculectomy at the time of cesarean delivery decreases wound complications in morbidly obese women. This is a retrospective cohort study of 59 morbidly obese patients who delivered via cesarean section at a single center between 2003 and 2009. A total of 30 morbidly obese patients who underwent modified panniculectomy at the time of cesarean section were compared to a control group of 29 morbidly obese women who underwent cesarean section alone. Of the 30 women who underwent modified panniculectomy at the time of cesarean, 3% (n = 1) developed operative site infection that required readmission. In the control group, 24% (n = 7) developed operative site infection (p = 0.026), and 10% (n = 3) were readmitted (p = 0.35). There was no difference in the postpartum length of hospital stay, intraoperative blood loss, operative time and infant delivery time between the two groups. In our cohort, morbidly obese women who underwent panniculectomy at the time of cesarean section had lower incidence of wound complications without significant increase in operative time, hospital length of stay, and infant delivery time. Modified panniculectomy at the time of cesarean may be a useful adjunct in an effort to decrease postoperative infectious morbidity in obese patients. However, the effects of the procedure on long-term healing,future obstetric outcomes, and other medical conditions warrant further evaluation.

  19. [Vaginal birth after cesarean section in light of international opinions].

    Science.gov (United States)

    Németh, Gábor; Molnár, András

    2017-07-01

    The tendency of increasing cesarean section rate has drawn worldwide attention. The vaginal birth after cesarean section is a useful method to decrease cesarean section rate at defined cases. Retrospective overview of factors resulting successful vaginal birth, labor/induction's condition, criterias, short and long term benefits and consequences. Overview recommendations of international guidelines and publications' results concerned vaginal birth after cesarean section in "PubMed", "MEDLINE", "Cochrane" databases from 1996 to 2016. Reviewing results of recommendations and publications we can declare that statements are inconsistent, however the option of vaginal birth after cesarean section is appropriate for decrease complications and trend of increasing cesarean section rate. It would be important in our country to define a uniform recommendation regarding vaginal birth after cesarean section, with supporting evidence in obstetrical and gynecological practice. Orv Hetil. 2017; 158(30): 1168-1174.

  20. Feasibility of abdominoplasty with Cesarean section

    OpenAIRE

    Sherif, Nadine

    2012-01-01

    This paper has been retracted. Wael Naeem Thabet1, Ahmad Samir Hossny1, Nadine Alaa Sherif21Department of General Surgery, 2Department of Obstetrics and Gynecology, Cairo University, Cairo, EgyptAbstract: Abdominoplasty is an esthetic surgical procedure that restores abdominal contouring. Repeated pregnancies combined with advancing maternal age usually lead to lower abdominal skin redundancy and excess fat accumulation. Delivery via Cesarean section adds weakness to the low...

  1. Acute parotiditis after cesarean section; case report

    Directory of Open Access Journals (Sweden)

    Cristina Moisei

    2017-11-01

    Full Text Available The enlargement of the parotid gland develops in inflammatory or stenotic conditions but after Cesarean section the symptomatology is unusual. A 38 year old patient with no obstetrical history referred to our clinic for pregnancy, which followed our national program of prenatal care. The outcome of the pregnancy was favorable for both mother and fetus. During labor the fetus developed bradycardia and the patient delivered by Cesarean section a 3400 g baby-boy with 8 Apgar Score; the anesthesia was spinal. 18 hours after delivery the patient presented mild respiratory distress. The symptomatology was caused by the enlargement of the parotid gland. The treatment was supportive and the remission occurred 10 hours after the onset. The initial discussion that raised this case was caused by the viral, infection and stenotic cause of the parotiditis. All these reasons had no medical argument. It was also debated about the anesthesia but, until now, the medical literature didn’t report any case of association between parotiditis and spinal anesthesia. It is also impossible to correlate the parotiditis with IVF procedure. As a conclusion, this case is unique because it represents the parotiditis without unknown case that appeared after Cesarean section and spinal anesthesia in a healthy woman.

  2. Feasibility of abdominoplasty with Cesarean section [Retraction

    Directory of Open Access Journals (Sweden)

    Thabet WN

    2013-01-01

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

  3. Is myomectomy safe during cesarean section in large myomas?

    OpenAIRE

    Senturk, Mehmet Baki; Budak, Mehmet Sukru; Cakmak, Yusuf; Turan, Kasim

    2015-01-01

    Objective: The rate of cesarean section, gravida and pregnancy age have been gradually increasing. Thus the rate of myoma have increased during cesarean. But it may difficult to make decision aboıut myomectomy during cesarean especially large myomas because of complications. Therefore, several obstetricians do not recommend cesarean myomectomy, except in cases of small and pedunculated uterine fibroids that do not result in complications.The aim of this study to evaluate safety of myomectomy ...

  4. [A case of Mycoplasma hominis infection after bladder injury during cesarean section].

    Science.gov (United States)

    Yagihashi, Yusuke; Kato, Keiji; Nagahama, Kanji; Yamamoto, Masakazu; Kanamaru, Hiroshi; Nishizawa, Hiromi; Ueda, Souhei; Nagano, Tadayoshi; Iito, Gouichi

    2011-09-01

    A 21-year-old female patient underwent emergency cesarean section and a postoperative hematoma occurred at the site of the uterine incision. The patient underwent laparotomy for hemostasis. An 3 cm perforation at the posterior wall of the bladder was identified. The bladder was repaired in two layers with an absorbable suture. Three days later she developed a fever of over 38 degrees C. Despite therapy with several antimicrobial agents, her fever persisted and the wound was opened. Computed tomography scan revealed an abscess at the site where the hematoma had formed. We present a case of severe wound infection that was caused by Mycoplasma hominis infection after cesarean section. Bladder perforation associated with cesarean section is uncommon. Mycoplasma hominis should be considered as a causative organism if an antimicrobial resistant infection occurs at the surgical site after a cesarean section.

  5. Changes in uterine flexion caused by cesarean section: correlation between post-flexion and deficient cesarean section scars.

    Science.gov (United States)

    Ryo, Eiji; Sakurai, Rina; Kamata, Hideo; Seto, Michiharu; Morita, Masayoshi; Ayabe, Takuya

    2016-04-01

    To investigate changes in uterine flexion after cesarean delivery in comparison with vaginal delivery, and their relationship with the presence of deficient cesarean section scars. In 147 women who had a vaginal delivery and 101 women who had a cesarean delivery, transvaginal ultrasonographic photographs of the uterus were obtained at the first trimester of pregnancy and at 1 month postpartum, and they were reviewed to determine changes in uterine flexion. The presence of a deficient cesarean section scar was also reviewed in women with a cesarean section. Changes in uterine flexion were observed more frequently among the woman with a cesarean delivery than in those with a vaginal delivery. The incidence of post-flexed uterus during puerperium tended to increase depending on the number of cesarean sections the woman had undergone. In the women with a cesarean section, changes in uterine flexion were more frequently observed in the women with a deficient cesarean section scar than in those without one. Changes in uterine flexion after birth occurred more frequently in the women who had a cesarean delivery than in those who had a vaginal delivery, especially in the presence of a deficient cesarean section scar.

  6. Vaginal birth after cesarean section-The world trend and local experience in Taiwan.

    Science.gov (United States)

    Tsai, Hsiu-Ting; Wu, Chia-Hsun

    2017-02-01

    The trend of increasing cesarean section rates had evoked worldwide attention. Many approaches were introduced to diminish cesarean section rates. Vaginal birth after cesarean section (VBAC) is a route of delivery with diverse agreements. In this study, we try to reveal the world trend in VBAC and our experience of a 10-year period in a medical center in northern Taiwan. This is a retrospective study of all women who underwent elective repeat cesarean delivery or trial of labor after cesarean (TOLAC) following primary cesarean delivery by a general obstetrician-gynecologist in the Tamshui Branch of MacKay Memorial Hospital (Taipei, Taiwan) between 2006 and 2015. We excluded cases of preterm labor, two or more cesarean deliveries, and major maternal diseases. We compared the characteristics and outcomes between these groups. We included 400 women with subsequent pregnancies who underwent elective repeat cesarean delivery or TOLAC during the study period. Among the study population, 112 women were excluded and 11 underwent repeat VBAC. A total of 204 (73.65%) cases underwent elective repeat cesarean delivery and 73 (26.35%) chose TOLAC. The rate of successful VBAC among the women who chose TOLAC was 84.93%. With respect to maternal and fetal safety, and success rates and adverse effects of VBAC, the results of this study are promising and compatible with the global data. It shows that a trial of VBAC can be offered to pregnant women without contraindications with high success rates. Copyright © 2017 Taiwan Association of Obstetrics & Gynecology. Published by Elsevier B.V. All rights reserved.

  7. Cesarean section imprints cord blood immune cell distributions

    DEFF Research Database (Denmark)

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

    2014-01-01

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

  8. Apnea 6 h after a cesarean section.

    Science.gov (United States)

    Farsi, Sara H

    2018-01-01

    Intrathecal narcotics have proven to be invaluable in providing pain relief following a cesarean section. They also aid in earlier mobilization. Unfortunately, they come at the risk of delayed apnea requiring close monitoring for a prolonged period of time. Physicians may sometimes underestimate the risk of these delayed complications. This especially a big concern in hospitals that cannot provide the necessary postoperative monitoring required for these women. I present a case where it took more than 6 h after injection of narcotics before the complication occurred.

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

    DEFF Research Database (Denmark)

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

    1994-01-01

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

  10. Fetomaternal hemorrhage in women undergoing elective cesarean section

    DEFF Research Database (Denmark)

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

    2010-01-01

    Objective. To investigate the degree of fetomaternal hemorrhage (FMH) caused by elective cesarean section. Design. Descriptive study. Settings. University Hospitals in Copenhagen, Denmark. Population. Women scheduled for elective cesarean section, in the period September 2007 to January 2009...... of fetal red blood cells (fRBCs) using flow cytometry. FMH associated with cesarean section was defined as the difference between the volumes of fRBCs in the two samples. Main Outcome Measures. The frequency and volume of FMH caused by elective cesarean section. Results. 207 women were included...

  11. Fetomaternal hemorrhage in women undergoing elective cesarean section

    DEFF Research Database (Denmark)

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

    2011-01-01

    OBJECTIVE: To investigate the degree of fetomaternal hemorrhage (FMH) caused by elective cesarean section. DESIGN: Descriptive study. SETTINGS: University Hospitals in Copenhagen, Denmark. POPULATION: Women scheduled for elective cesarean section, in the period September 2007 to January 2009...... of fetal red blood cells (fRBCs) using flow cytometry. FMH associated with cesarean section was defined as the difference between the volumes of fRBCs in the two samples. MAIN OUTCOME MEASURES: The frequency and volume of FMH caused by elective cesarean section. RESULTS: 207 women were included...

  12. Effect of Iranian Ministry of Health protocols on cesarean section rate: a quasi-experimental study.

    Science.gov (United States)

    Yavangi, Mahnaz; Sohrabi, Mohammad-Reza; Alishahi Tabriz, Amir

    2013-05-29

    High Cesarean section rate is a major health problem in developing countries. This study was established to evaluate the effectiveness of Iranian Ministry of Health and Medical Education protocols on Cesarean section rate trend. Through a non-concurrent controlled quasi-experimental study, Cesarean section rate in Shohada-e-Tajrish and Taleghani hospitals in Tehran was compared during 2008-2009. Intervention group included 578 participants hospitalized because of premature rupture of membranes, prolonged pregnancy, pre-eclampsia, intra-uterine growth retardation, vaginal bleeding and premature labor in first and second trimester underwent interventions based on MOHME new protocol. On the other hand 594 cases as control group were selected during the same time before the intervention and underwent routine treatments. Descriptive statics, t-test, chi square and univariate analysis were used when appropriate. Basic characteristics in two groups had no statistically significant difference. Cesarean section applied for 360 (67.8%) women in case group and on the other hand, 270 (48.8%) Cesarean sections were done for control group (PComplication of pregnancies had increased by 6% in intervention group (PCesarean section rate. Providing appropriate service may increase the ability of service providers to find more indications for Cesarean section.

  13. Rising trends in cesarean section rates in Egypt.

    Science.gov (United States)

    Khawaja, Marwan; Jurdi, Rozzet; Kabakian-Khasholian, Tamar

    2004-03-01

    Cesarean section rates have been increasing worldwide, but little research exists on trends of cesarean section delivery for any country in the Arab world. The purpose of this study was to document recent levels and trends of cesarean section rates in Egypt, and to estimate trends in cesarean section by type of hospital from three population-based national surveys. This descriptive study used merged data files from three nationally representative samples of ever-married women aged 15 to 49 years. A significant rise in cesarean deliveries occurred for all births, from a low of 4.6 percent in 1992 to 10.3 percent in 2000. However, hospital-based cesarean deliveries were much higher in 1987-1988 (13.9%), increasing to 22.0 percent in 1999-2000. Although the cesarean section rate was slightly higher in private hospitals, the rate also increased consistently in public hospitals. The high and unprecedented increase in cesarean section rates reported in this study may be partly due to cesarean sections that are not medically indicated, and suggest that physician practice patterns, financial incentives or other profitability factors, and patient preferences should be explored.

  14. Placental Chorangiosis: Increased Risk for Cesarean Section

    Directory of Open Access Journals (Sweden)

    Shariska S. Petersen

    2017-01-01

    Full Text Available We describe a patient with Class C diabetes who presented for nonstress testing at 36 weeks and 4 days of gestation with nonreassuring fetal heart tones (NRFHT and oligohydramnios. Upon delivery, thrombosis of the umbilical cord was grossly noted. Pathological analysis of the placenta revealed chorangiosis, vascular congestion, and 40% occlusion of the umbilical vein. Chorangiosis is a vascular change of the placenta that involves the terminal chorionic villi. It has been proposed to result from longstanding, low-grade hypoxia in the placental tissue and has been associated with such conditions such as diabetes, intrauterine growth restriction (IUGR, and hypertensive conditions in pregnancy. To characterize chorangiosis and its associated obstetric outcomes we identified 61 cases of “chorangiosis” on placental pathology at Henry Ford Hospital from 2010 to 2015. Five of these cases were omitted due to lack of complete records. Among the 56 cases, the cesarean section rate was 51%, indicated in most cases for nonreassuring fetal status. Thus, we suggest that chorangiosis, a marker of chronic hypoxia, is associated with increased rates of cesarean sections for nonreassuring fetal status because of long standing hypoxia coupled with the stress of labor.

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

    Science.gov (United States)

    Cho, Hee Young; Park, Yong Won; Kim, Young Han; Jung, Inkyung; Kwon, Ja-Young

    2015-01-01

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

  16. Cesarean section in alpacas and llamas: 34 cases (1997-2010).

    Science.gov (United States)

    Miller, Bret A; Brounts, Sabrina H; Anderson, David E; Devine, Elizabeth

    2013-03-01

    To determine indications for cesarean section in alpacas and llamas, and clinical management and outcome of alpacas and llamas undergoing cesarean section. Retrospective case series. 27 alpacas and 7 llamas. Medical records were reviewed and information gathered on signalment, anamnesis including reproductive history, physical examination findings, indication for cesarean section, anesthetic protocol, surgical technique, number of crias delivered (alive or dead), additional treatment, duration of hospitalization, and postoperative complications. Follow-up information was gathered via email or telephone interview with owners. Uterine torsion (13/34 [38%]) was the most common reason for cesarean section. The most common surgical approach was the left proximal lateral abdominal approach (21/34 [62%]). Thirty-four crias were delivered via cesarean section. Twenty (59%) were born alive and discharged from the hospital. Retained placenta was the most common complication observed after surgery. A significant association was found between prolonged dystocia and fetal death. Of the 34 dams that underwent cesarean section, 21 were rebred, and 19 of the 21 (90.5%) dams that were rebred became pregnant. Fifteen of 19 dams were confirmed to have ≥ 1 normal vaginal delivery with a live cria following cesarean section. The results of the present study indicated that cesarean section was an effective method of resolving dystocia in camelids without negatively affecting future fertility or parturition by the dam. Prompt referral of patients with dystocia is advised to improve fetal viability. Retained fetal membranes seemed to be a common complication of cesarean section in camelids but was not associated with negative outcomes.

  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. Fetal outcome in emergency versus elective cesarean sections at ...

    African Journals Online (AJOL)

    Introduction: Perinatal mortality rates have come down in cesarean sections, but fetal morbidity is still high in comparison to vaginal delivery and the complications are more commonly seen in emergency than in elective cesarean sections. The objective of the study was to compare the fetal outcome and the indications in ...

  19. Cesarean section imprints cord blood immune cell distributions

    DEFF Research Database (Denmark)

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

    2014-01-01

    Immune programming in early life may affect the risk of developing immune-related diseases later in life. Children born by cesarean section seem to be at higher risk of asthma, allergic rhinitis, and type-1 diabetes. We hypothesized that delivery by cesarean section may affect immune maturation...

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

    Directory of Open Access Journals (Sweden)

    Silvia Minicucci

    2012-01-01

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

  1. Applying Lean Six Sigma methodology to reduce cesarean section rate.

    Science.gov (United States)

    Chai, Ze-Ying; Hu, Hua-Min; Ren, Xiu-Ling; Zeng, Bao-Jin; Zheng, Ling-Zhi; Qi, Feng

    2017-06-01

    This study aims to reduce cesarean section rate and increase rate of vaginal delivery. By using Lean Six Sigma (LSS) methodology, the cesarean section rate was investigated and analyzed through a 5-phase roadmap consisting of Define, Measure, Analyze, Improve, and Control. The principal causes of cesarean section were identified, improvement measures were implemented, and the rate of cesarean section before and after intervention was compared. After patients with a valid medical reason for cesarean were excluded, the main causes of cesarean section were maternal request, labor pain, parturient women assessment, and labor observation. A series of measures was implemented, including an improved parturient women assessment system, strengthened pregnancy nutrition guidance, implementation of painless labor techniques, enhanced midwifery team building, and promotion of childbirth-assist skills. Ten months after introduction of the improvement measures, the cesarean section rate decreased from 41.83% to 32.00%, and the Six Sigma score (ie, Z value) increased from 1.706 to 1.967 (P cesarean section. © 2016 John Wiley & Sons, Ltd.

  2. Fetomaternal hemorrhage in women undergoing elective cesarean section

    DEFF Research Database (Denmark)

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

    2010-01-01

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

  3. Risk factors for persistent pain and its influence on maternal wellbeing after cesarean section.

    Science.gov (United States)

    Niklasson, Boel; Georgsson Öhman, Susanne; Segerdahl, Märta; Blanck, Agneta

    2015-06-01

    To investigate the overall incidence and risk factors for persistent pain and its interference with daily life after cesarean section. Prospective long-term follow-up study. Karolinska University Hospital, Stockholm, Sweden. 260 healthy women who underwent elective cesarean section. Information on demographics, medical history, postoperative pain and analgesic requirements was collected. A questionnaire consisting of the Brief Pain Inventory was posted at 3, 6 and 12 months after surgery. Women rated pain intensity as well as interference with factors related to general function and quality of life. The overall incidence and risk factors for persistent postoperative pain at three time points. Persistent pain was considered a secondary outcome. At 3, 6 and 12 months respectively 40, 27 and 22% of patients reported pain in one or more locations, in the surgical site as well as in other areas. A psychological indication, as well as a first cesarean section, increased the risk for pain at 3 months. Severe postoperative pain in the immediate postoperative period or undergoing a first cesarean section were significant independent risk factors for the development of persistent pain up to 6 months after cesarean section. Parameters related to quality of life were significantly impaired in women with persistent pain. Several factors, including severe postoperative pain, were shown to influence the risk for persistent pain after cesarean section. Long-term pain markedly affected women's wellbeing. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

  4. 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.

  5. Delivery outcomes at term after one previous cesarean section.

    Science.gov (United States)

    Yamani-Zamzami, Tarik Y

    2007-12-01

    To determine the maternal and perinatal outcomes at term in women with one previous cesarean delivery and with no history of vaginal birth. This is a case-control study conducted at King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia, between January 1, 1999 and December 31, 2002. One hundred sixty-two women with one previous cesarean delivery and with no previous vaginal birth were compared with 324 control women. The cesarean section rate was higher in the study group 40 (24.7%) versus 23 (7.1%) in the control group and was statistically significant (phistory of vaginal delivery are considered less favorable, the vaginal birth after cesarean section success rate may be even lower if the indication for previous primary cesarean delivery was failure to progress, and may be associated with increased risk of uterine rupture. Further study is required to confirm our findings.

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

    Directory of Open Access Journals (Sweden)

    Hee Young Cho

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

  7. Cesarean Section and Chronic Immune Disorders

    DEFF Research Database (Denmark)

    Sevelsted, Astrid; Stokholm, Jakob; Bønnelykke, Klaus

    2015-01-01

    analyses. RESULTS: Children delivered by cesarean delivery had significantly increased risk of asthma, systemic connective tissue disorders, juvenile arthritis, inflammatory bowel disease, immune deficiencies, and leukemia. No associations were found between cesarean delivery and type 1 diabetes, psoriasis......OBJECTIVES: Immune diseases such as asthma, allergy, inflammatory bowel disease, and type 1 diabetes have shown a parallel increase in prevalence during recent decades in westernized countries. The rate of cesarean delivery has also increased in this period and has been associated...... with the development of some of these diseases. METHODS: Mature children born by cesarean delivery were analyzed for risk of hospital contact for chronic immune diseases recorded in the Danish national registries in the 35-year period 1977-2012. Two million term children participated in the primary analysis. We...

  8. Anesthesia for combined cesarean section and pheochromocytoma resection

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    Sadhana Kulkarni

    2017-01-01

    Full Text Available Pheochromocytoma (PCC is a rare cause of hypertension during pregnancy [1:54000 pregnancies]. Fetomaternal morbidity and mortality is about 58% if the diagnosis is missed. Administration of anesthesia to patients with PCC is challenging. Associated pregnancy adds to the problems. This is a case report of a patient having PCC diagnosed at 26 weeks of gestation. With medical management pregnancy was continued till 34 weeks. She was posted for cesarean section and resection of PCC. Patient underwent surgery lasting for 7 h due to inferior vena cava tear and had stormy intra as well as postoperative course. Mother and baby had uneventful recovery due to continuous invasive monitoring and a good teamwork, despite limited anesthetic resources.

  9. Omental Evisceration after Cesarean Section: Safety of Peritoneal Nonclosure Technique

    OpenAIRE

    Bhattacharya, Sohini; Bhattacharyya, Sanjay Kumar; Alam, Hajekul; Ghosh Roy, Samir Chandra

    2011-01-01

    A case of omental prolapse presented to us on the fifteenth postoperative day following an uneventful Cesarean section. A rare complication as such questions the safety of peritoneal nonclosure that has been adopted by obstetricians in recent times.

  10. TAP Catheters Versus Intrathecal Morphine for Cesarean Section

    Science.gov (United States)

    2012-05-07

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

  11. Effects of Music during Multiple Cesarean Section Delivery.

    Science.gov (United States)

    Handan, Eren; Sahiner, Nejla Canbulat; Bal, Meltem Demirgoz; Dissiz, Melike

    2018-03-01

    This experimental study was conducted to determine the level of anxiety in women undergoing multiple cesarean section. Sixty multiple cesarean section referrals were randomly assigned to either the experimental or control groups. Data was collected at the Karaman Public Health Hospital in Turkey, from June 2015 to June 2016. Songs chosen earlier by the patients were played during the cesarean section procedure for the experimental group. The control group was studied without music. Data was collected using a questionnaire form, and Visual Analogue Scale (VAS) was used to determine the anxiety levels. The t-test and chi-square test were used to analyse statistically significant differences between the groups. The VAS scores before and during the procedure showed significantly lower scores for the experimental group, compared to the control group (p<0.05). Music therapy reduces the physiological and cognitive responses of anxiety in patients undergoing multiple cesarean section, and can be used in the clinical practice.

  12. Prelabor Cesarean Section and Risk of Childhood Type 1 Diabetes

    DEFF Research Database (Denmark)

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

    2016-01-01

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

  13. Indications for and Risks of Elective Cesarean Section.

    Science.gov (United States)

    Mylonas, Ioannis; Friese, Klaus

    2015-07-20

    Rates of cesarean section have risen around the world in recent years. Accordingly, much effort is being made worldwide to understand this trend and to counteract it effectively. A number of factors have been found to make it more likely that a cesarean section will be chosen, but the risks cannot yet be clearly defined. This review is based on pertinent publications that were retrieved by a selective search in the PubMed, Scopus, and DIMDI databases, as well as on media communications, analyses by the German Federal Statistical Office, and guidelines of the Association of Scientific Medical Societies in Germany (AWMF). The increased rates of cesarean section are thought to be due mainly to changed risk profiles both for expectant mothers and for their yet unborn children, as well as an increase in cesarean section by maternal request. In 1991, 15.3% of all newborn babies in Germany were delivered by cesarean section; by 2012, the corresponding figure was 31.7%, despite the fact that a medical indication was present in less than 10% of all cases. This development may perhaps be explained by an increasing tendency toward risk avoidance, by risk-adapted obstetric practice, and increasing media attention. The intraoperative and postoperative risks of cesarean section must be considered, along with complications potentially affecting subsequent pregnancies. Scientific advances, social and cultural changes, and medicolegal considerations seem to be the main reasons for the increased acceptibility of cesarean sections. Cesarean section is, however, associated with increased risks to both mother and child. It should only be performed when it is clearly advantageous.

  14. Non-obstructive cecal dilatation and perforation after cesarean section

    DEFF Research Database (Denmark)

    Sperling, Lene; Schantz, A L; Toftager-Larsen, K

    1990-01-01

    A case of non-obstructive cecal dilatation and perforation after cesarean section is reported, with a review of the literature on the diagnosis and management of this entity. Fifteen cases have been described. Attention is called to this rare complication and to the accompanying pseudo......-obstructive syndrome, the diagnosis of which is important in order to avoid cecal perforation. Non-obstructive cecal dilatation is a life threatening complication to cesarean section, and immediate surgical intervention is important....

  15. Cesarean section in Ethiopia: prevalence and sociodemographic characteristics.

    Science.gov (United States)

    Yisma, Engida; Smithers, Lisa G; Lynch, John W; Mol, Ben W

    2017-11-20

    The objective of this study was to assess the prevalence and sociodemographic characteristics of cesarean section in Ethiopia. We used data collected for Ethiopia Demographic and Health Surveys (DHS) conducted in 2000, 2005, 2011, and 2016. A two-stage, stratified, clustered random sampling design was used to gather information from women who gave birth within the 5-year period before each of the surveys. We analyzed the data to identify sociodemographic characteristics associated with cesarean section using log-Poisson regression models. The national cesarean section rate increased from 0.7% in 2000 to 1.9% in 2016, with increases across seven of the eleven administrative regions of Ethiopia. Addis Ababa had the highest cesarean section rate (21.4%) in 2016 and the greatest increase since 2000. In the adjusted analysis, women who gave birth in private health facility had a 78.0% higher risk of cesarean section (adjusted prevalence ratio (aPR) (95% CI) 1.78 (1.22, 2.58)) compared with women who gave birth in public health facility. Having four or more births was associated with a lower risk of cesarean section compared with first births (aPR (95% CI) 0.36 (0.16, 0.79)). The Ethiopian national cesarean section rate is about 2%, but the rate varies widely among administrative regions, suggesting unequal access. Cesarean sections were highest among urban mothers, first births, births to women with higher education, and births to women from the richest quintile of household wealth.

  16. Impact of clinical audits on cesarean section rate.

    Science.gov (United States)

    Peng, Fu-Shiang; Lin, Hsien-Ming; Lin, Ho-Hsiung; Tu, Fung-Chao; Hsiao, Chin-Fen; Hsiao, Sheng-Mou

    2016-08-01

    Many countries have noted a substantial increase in the cesarean section rate (CSR). Several methods for lowering the CSR have been described. Understanding the impact of clinical audits on the CSR may aid in lowering CSR. Thus, our aim is to elucidate the effect of clinical audits on the CSR. We retrospectively analyzed 3781 pregnant women who gave birth in a medical center between January 2008 and January 2011. Pregnant women who delivered between January 2008 and July 2009 were enrolled as the pre-audit group (n = 1592). After August 2009, all cesarean section cases that were audited were enrolled in the audit group (n = 2189). The CSR was compared between groups. The overall CSR (34.5% vs. 31.1%, adjusted odds ratio [OR] = 0.83, p = 0.008) and the cesarean section rate due to dystocia (9.6% vs. 6.2%, p cesarean section was achieved in 16 (8.2%) of 195 audit cases in the monthly audit conference. In nulliparous pregnant women (n = 2148), multivariate analysis revealed that clinical audit (OR = 0.78), maternal age (OR = 1.10), gestational age at delivery (OR = 0.80), and fetal body weight at birth (OR = 1.0005) were independent predictors of cesarean section (all p cesarean section to reduce the CSR. Copyright © 2016. Published by Elsevier B.V.

  17. Classifications for cesarean section: a systematic review.

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    Maria Regina Torloni

    Full Text Available BACKGROUND: Rising cesarean section (CS rates are a major public health concern and cause worldwide debates. To propose and implement effective measures to reduce or increase CS rates where necessary requires an appropriate classification. Despite several existing CS classifications, there has not yet been a systematic review of these. This study aimed to 1 identify the main CS classifications used worldwide, 2 analyze advantages and deficiencies of each system. METHODS AND FINDINGS: Three electronic databases were searched for classifications published 1968-2008. Two reviewers independently assessed classifications using a form created based on items rated as important by international experts. Seven domains (ease, clarity, mutually exclusive categories, totally inclusive classification, prospective identification of categories, reproducibility, implementability were assessed and graded. Classifications were tested in 12 hypothetical clinical case-scenarios. From a total of 2948 citations, 60 were selected for full-text evaluation and 27 classifications identified. Indications classifications present important limitations and their overall score ranged from 2-9 (maximum grade =14. Degree of urgency classifications also had several drawbacks (overall scores 6-9. Woman-based classifications performed best (scores 5-14. Other types of classifications require data not routinely collected and may not be relevant in all settings (scores 3-8. CONCLUSIONS: This review and critical appraisal of CS classifications is a methodologically sound contribution to establish the basis for the appropriate monitoring and rational use of CS. Results suggest that women-based classifications in general, and Robson's classification, in particular, would be in the best position to fulfill current international and local needs and that efforts to develop an internationally applicable CS classification would be most appropriately placed in building upon this

  18. Classifications for cesarean section: a systematic review.

    Science.gov (United States)

    Torloni, Maria Regina; Betran, Ana Pilar; Souza, Joao Paulo; Widmer, Mariana; Allen, Tomas; Gulmezoglu, Metin; Merialdi, Mario

    2011-01-20

    Rising cesarean section (CS) rates are a major public health concern and cause worldwide debates. To propose and implement effective measures to reduce or increase CS rates where necessary requires an appropriate classification. Despite several existing CS classifications, there has not yet been a systematic review of these. This study aimed to 1) identify the main CS classifications used worldwide, 2) analyze advantages and deficiencies of each system. Three electronic databases were searched for classifications published 1968-2008. Two reviewers independently assessed classifications using a form created based on items rated as important by international experts. Seven domains (ease, clarity, mutually exclusive categories, totally inclusive classification, prospective identification of categories, reproducibility, implementability) were assessed and graded. Classifications were tested in 12 hypothetical clinical case-scenarios. From a total of 2948 citations, 60 were selected for full-text evaluation and 27 classifications identified. Indications classifications present important limitations and their overall score ranged from 2-9 (maximum grade =14). Degree of urgency classifications also had several drawbacks (overall scores 6-9). Woman-based classifications performed best (scores 5-14). Other types of classifications require data not routinely collected and may not be relevant in all settings (scores 3-8). This review and critical appraisal of CS classifications is a methodologically sound contribution to establish the basis for the appropriate monitoring and rational use of CS. Results suggest that women-based classifications in general, and Robson's classification, in particular, would be in the best position to fulfill current international and local needs and that efforts to develop an internationally applicable CS classification would be most appropriately placed in building upon this classification. The use of a single CS classification will facilitate

  19. Comparison of Respiratory Morbidity Incidence in Term Newborns Born by Elective Cesarean Section and Emergency Cesarean Section

    OpenAIRE

    Kh. Mani Kashani; N. Pezeshki; M.H. Azimian

    2005-01-01

    Introduction & Objective: Although emergency cesarean section is performed to save mother and neonate life in many cases, but this is not always safe in all cases, especially in elective one. In addition to maternal problems it can increases neonatal morbidity and mortality rate especially in term neonates. One of the most prominent problems in this regard is neonatal respiratory distress following elective cesarean section, which are studied in this research.Materials & Methods : This was a ...

  20. [Anesthesia for cesarean section in a patient with isolated unilateral absence of a pulmonary artery].

    Science.gov (United States)

    Furuya, Tomonori; Iida, Ryoji; Konishi, Jyumpei; Kato, Jitsu; Suzuki, Takahiro

    Congenital unilateral absence of a pulmonary artery (UAPA) is a rare anomaly. Although there are several reports regarding pregnancy in patients with unilateral absence of a pulmonary artery, there are no case reports describing anesthesia for Cesarean section in a patient with unilateral absence of a pulmonary artery. We present a patient with unilateral absence of a pulmonary artery who underwent Cesarean sections twice at the ages of 24 and 26 years under spinal anesthesia for surgery and epidural analgesia for postoperative pain relief. Both times, spinal anesthesia and epidural analgesia enabled successful anesthesia management without the development of either pulmonary hypertension or right heart failure. Spinal anesthesia combined with epidural analgesia is a useful anesthetic method for a Cesarean section in patients with unilateral absence of a pulmonary artery. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  1. Anesthesia for cesarean section in a patient with isolated unilateral absence of a pulmonary artery.

    Science.gov (United States)

    Furuya, Tomonori; Iida, Ryoji; Konishi, Jyumpei; Kato, Jitsu; Suzuki, Takahiro

    Congenital unilateral absence of a pulmonary artery (UAPA) is a rare anomaly. Although there are several reports regarding pregnancy in patients with unilateral absence of a pulmonary artery, there are no case reports describing anesthesia for Cesarean section in a patient with unilateral absence of a pulmonary artery. We present a patient with unilateral absence of a pulmonary artery who underwent Cesarean sections twice at the ages of 24 and 26 years under spinal anesthesia for surgery and epidural analgesia for postoperative pain relief. Both times, spinal anesthesia and epidural analgesia enabled successful anesthesia management without the development of either pulmonary hypertension or right heart failure. Spinal anesthesia combined with epidural analgesia is a useful anesthetic method for a Cesarean section in patients with unilateral absence of a pulmonary artery. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  2. The Role of Xylitol Gum Chewing in Restoring Postoperative Bowel Activity After Cesarean Section.

    Science.gov (United States)

    Lee, Jian Tao; Hsieh, Mei-Hui; Cheng, Po-Jen; Lin, Jr-Rung

    2016-03-01

    The goal of this study was to evaluate the effects of xylitol gum chewing on gastrointestinal recovery after cesarean section. Women who underwent cesarean section (N = 120) were randomly allocated into Group A (xylitol gum), Group B (nonxylitol gum), or the control group (no chewing gum). Every 2 hr post-cesarean section and until first flatus, Groups A and B received two pellets of chewing gum and were asked to chew for 15 min. The times to first bowel sounds, first flatus, and first defecation were then compared among the three groups. Group A had the shortest mean time to first bowel sounds (6.9 ± 1.7 hr), followed by Group B (8 ± 1.6 hr) and the control group (12.8 ± 2.5 hr; one-way analysis of variance, p xylitol-containing gum may be superior to xylitol-free gum. © The Author(s) 2015.

  3. Effects of cesarean section on mean platelet volume.

    Science.gov (United States)

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

    2015-01-01

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

  4. Hysteroscopic findings in patients with post-menstrual spotting with prior cesarean section

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    Valdely Helena Talamonte

    2012-03-01

    Full Text Available Objective: To identify uterine hysteroscopic findings among patientswith prior cesarean section and whom had post-menstrual bleedingspotting type. Methods: We conducted a descriptive and prospective study between June 2008 and December 2009 involving women admitted to our clinic in Ji-Paraná (RO, Brazil, and who complained of prolonged genital bleeding after menstrual period. A total of 20 women with the simultaneous following characteristics were selected: at least one prior cesarean section, aged between 18 and 45 years, no use of hormonal contraceptives, and no history of uterine surgery that could change the cavity anatomy. All participants underwent a hysteroscopic examination. Results: During hysteroscopy, in 90% of the patients, the presence of a cesarean section scar was observed in the last third of the cervix. This scarring causes an anomaly in the uterine cavity anatomy, characterized by the viewing of an enlargement followed by a retraction of the anterior wall, which affords the presence of a pseudocavity with depth and lumen narrowing in variable degrees. Two patients did not present the pseudocavity. Conclusion: Pseudocavities in cesarean section scar are usually found in hysteroscopic examination of patients with prior cesarean section and abnormal uterine spotting.

  5. [Increased prevalence of congenital dacryostenosis following cesarean section].

    Science.gov (United States)

    Kuhli-Hattenbach, Claudia; Lüchtenberg, M; Hofmann, C; Kohnen, T

    2016-08-01

    Congenital nasolacrimal duct obstruction (dacryostenosis) with a persisting membrane at Hasner's valve is the most common cause of persistent tear and ocular discharge in infants. To evaluate whether there is an association between congenital dacryostenosis and delivery via cesarean section. In a prospective study we examined 107 children (mean age 9.2 ± 7.1 months) with congenital dacryostenosis. We evaluated data about the mode of delivery (vaginal delivery versus cesarean section) and gestational age at the time of birth. Within the first 8 months of life children were treated by probing using local anesthesia, whereas older children were treated using general anesthesia. After the age of 11 months treatment included nasolacrimal duct intubation with a bicanalicular stent. Statistical analyses were performed using binomial tests, Fisher's exact test and the t-test. In this study 51 children delivered by cesarean section were compared with 56 children delivered by spontaneous vaginal delivery. A total of 44 age-matched pairs from both groups were evaluated in order to eliminate confounding factors due to gestational age at delivery. Based on the published rate of cesarean sections from the same region of the State of Hesse between 2002-2004 we observed a statistically significant association between congenital dacryostenosis and delivery by cesarean section among the 88 age-matched patients (P = 0.009). Moreover, subgroup analysis revealed a significant association between congenital dacryostenosis and delivery by primary cesarean section (P = 0.00004). The prevalence of surgical treatment was not statistically different between both groups based on the mode of delivery (P = 0.8). Our results suggest that delivery via cesarean section is associated with a significantly higher prevalence of congenital dacryostenosis.

  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. Cesarean section and offspring's risk of multiple sclerosis

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  8. Risk factors for surgical site infection after low transverse cesarean section.

    Science.gov (United States)

    Olsen, Margaret A; Butler, Anne M; Willers, Denise M; Devkota, Preetishma; Gross, Gilad A; Fraser, Victoria J

    2008-06-01

    Independent risk factors for surgical site infection (SSI) after cesarean section have not been well documented, despite the large number of cesarean sections performed and the relatively common occurrence of SSI. To determine independent risk factors for SSI after low transverse cesarean section. Retrospective case-control study. Barnes-Jewish Hospital, a 1,250-bed tertiary care hospital. A total of 1,605 women who underwent low transverse cesarean section during the period from July 1999 to June 2001. Using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for SSI or wound complication and/or data on antibiotic use during the surgical hospitalization or at readmission to the hospital or emergency department, we identified potential cases of SSI in a cohort of patients who underwent a low transverse cesarean section. Cases of SSI were verified by chart review using the definitions from the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance System. Control patients without SSI or endomyometritis were randomly selected from the population of patients who underwent cesarean section. Independent risk factors for SSI were determined by logistic regression. SSIs were identified in 81 (5.0%) of 1,605 women who underwent low transverse cesarean section. Independent risk factors for SSI included development of subcutaneous hematoma after the procedure (adjusted odds ratio [aOR], 11.6 [95% confidence interval [CI], 4.1-33.2]), operation performed by the university teaching service (aOR, 2.7 [95% CI, 1.4-5.2]), and a higher body mass index at admission (aOR, 1.1 [95% CI, 1.0-1.1]). Cephalosporin therapy before or after the operation was associated with a significantly lower risk of SSI (aOR, 0.2 [95% CI, 0.1-0.5]). Use of staples for skin closure was associated with a marginally increased risk of SSI. These independent risk factors should be incorporated into approaches for the prevention

  9. Niches after cesarean section in a population seeking hysteroscopic sterilization.

    Science.gov (United States)

    van der Voet, Lucy Lucet F; Limperg, Tobias; Veersema, Sebastiaan; Timmermans, Anne; Bij de Vaate, A Marjolein J; Brölmann, Hans A M; Huirne, Judith A F

    2017-07-01

    To study the prevalence of hysteroscopically evaluated disruptions of the integrity of the uterine wall ('niches') in women with and without a previous cesarean section. A prospective cohort study was performed in a teaching hospital in the Netherlands. Women seeking hysteroscopic sterilization were included. A hysteroscopic evaluation of the anterior wall of the uterus and cervix to identify the existence of disruptions (niches) was performed in a standard manner. Primary outcome was the presence of a uterine niche, defined as any visible defect, disruption, or concavity (gap) in the anterior wall. Secondary outcome was to develop a registration form of niche features for hysteroscopic evaluation. In total, 713 women were included, 603 without and 110 with a previous cesarean section. In women with a previous cesarean Section 83 (75%) niches were observed using hysteroscopy. Anterior wall disruptions were not observed in women without a cesarean section. The following niche features were identified and incorporated in a registration form: polyps, cysts, myometrium defect, fibrotic tissue, (abnormal) vascular pattern, lateral branches, mucus production inside the defect, and bleeding. In a prospective cohort study among women undergoing hysteroscopic sterilization, a uterine niche could be detected by hysteroscopy in 75% of women with a previous cesarean section. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Efforts to promote vaginal delivery after a previous cesarean section.

    Science.gov (United States)

    Hamai, Yoko; Imanishi, Yukio

    2012-01-01

    The aim of this study was to examine the results of vaginal delivery in patients with a past history of cesarean section. The type of delivery, interventions during delivery, and the prognoses of the mothers and babies were examined in 145 women with a history of cesarean section over the 10-year period from January 2000 to December 2009. A scheduled cesarean section was performed in 27 cases. Vaginal delivery was recommended in 118 cases and the success rate was 94.9% (112/118). Uterine rupture was observed in one patient who experienced a natural rupture at home and whose previous cesarean section was an inverse T incision. No cases required a blood transfusion or hysterectomy. The prognoses of both mothers and babies were good and the vaginal delivery success rate was 94.9%. Uterine rupture was observed in one case. Vaginal delivery with previous cesarean section should be considered in cases with expectation and informed consent. © 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.

  11. Fetal outcome in emergency versus elective cesarean sections at Souissi Maternity Hospital, Rabat, Morocco

    Science.gov (United States)

    Benzouina, Soukayna; Boubkraoui, Mohamed El-mahdi; Mrabet, Mustapha; Chahid, Naima; Kharbach, Aicha; El-hassani, Amine; Barkat, Amina

    2016-01-01

    Introduction Perinatal mortality rates have come down in cesarean sections, but fetal morbidity is still high in comparison to vaginal delivery and the complications are more commonly seen in emergency than in elective cesarean sections. The objective of the study was to compare the fetal outcome and the indications in elective versus emergency cesarean section performed in a tertiary maternity hospital. Methods This comparative cross-sectional prospective study of all the cases undergoing elective and emergency cesarean section for any indication at Souissi maternity hospital of Rabat, Morocco, was carried from January 1, to February 28, 2014. Data were analyzed with emphasis on fetal outcome and cesarean sections indications. Mothers who had definite antenatal complications that would adversely affect fetal outcome were excluded from the study. Results There was 588 (17.83%) cesarean sections among 3297 births of which emergency cesarean section accounted for 446 (75.85%) and elective cesarean section for 142 cases (24.15%). Of the various factors analyzed in relation to the two types of cesarean sections, statistically significant associations were found between emergency cesarean section and younger mothers (P cesarean section performed under general anesthesia (P cesarean section was fetal distress (30.49%), while the most frequent indication in elective cesarean section was previous cesarean delivery (47.18%). Conclusion The overall fetal complications rate was higher in emergency cesarean section than in elective cesarean section. Early recognition and referral of mothers who are likely to undergo cesarean section may reduce the incidence of emergency cesarean sections and thus decrease fetal complications. PMID:27347286

  12. Prevention of cesarean section. Does intracervical dinoprostone work?

    Science.gov (United States)

    Gilson, G J; Izquierdo, L A; Chatterjee, M S; Curet, L B; Qualls, C R

    1993-01-01

    We investigated the effect of preinduction cervical ripening with the intracervical instillation of dinoprostone (prostaglandin E2 gel, 0.5 mg) on the results of labor induced with intravenous oxytocin. We randomly allocated 79 pregnant women to receive either the intracervial application of dinoprostone gel or placebo gel. Compared with control subjects, the group who received dinoprostone had no difference in induction-to-delivery interval or in cesarean section rate. The dinoprostone group had fewer failed inductions, but there was no difference between the two groups in the number who delivered spontaneously within 24 hours. From review of the literature and a meta-analysis, it was likewise revealed that dinoprostone did not favorably affect the cesarean section rate. Contrary to current opinion, intracervical dinoprostone gel does not appreciably lower the cesarean section rate when used at this dose and route before labor is induced. PMID:8212680

  13. Repair of a vesicouterine fistula following cesarean section.

    Science.gov (United States)

    Milani, Rodolfo; Cola, Alice; Frigerio, Matteo; Manodoro, Stefano

    2018-02-01

    Vesicouterine fistula is a rare complication of cesarean section. The aim of this video is to present a case report and to provide a tutorial on the surgical technique of delayed transvaginal repair of a high vesicouterine fistula that developed after cesarean section with manual removal of a morbidly adherent placenta. A 43-year-old woman was referred to our unit for continuous urinary leakage 3 months after undergoing a cesarean section with manual removal of a morbidly adherent placenta. A vesicouterine fistula starting from the posterior bladder wall was identified. The surgical repair consisted of a transvaginal layered repair as shown in the video. No surgical complications were observed postoperatively. Two months after surgery the fistula had not recurred and the patient reported no urinary leakage. Transvaginal layered primary repair of vesicouterine fistula was shown to be a safe and effective procedure for restoring continence. The vaginal route can be particularly attractive for urogynecological surgeons.

  14. Cervical Abscess with Vaginal Fistula After Extraperitoneal Cesarean Section

    Directory of Open Access Journals (Sweden)

    Ching-Yu Chou

    2007-12-01

    Full Text Available Extraperitoneal cesarean section was once used for the prevention of infection and postoperative adhesion. However, we report an unusual complication after this procedure. A 29-year-old woman had pus discharge from the anterior vaginal wall after extraperitoneal cesarean section. Broad-spectrum antibiotics failed to relieve her symptoms and vaginal culture yielded Morganella morganii. Magnetic resonance imaging, sagittal view, showed a cervical abscess measuring 5 × 5 cm with a tract extending to the anterior vagina. After performing dilation and abscess drainage via the cervical ostium, the symptoms gradually subsided with adequate antibiotic treatment. Cervical abscess may develop after extraperitoneal cesarean section and present initially as vaginal fistula. Detailed imaging study provides comprehensive anatomic information for effective management.

  15. Cesarean Birth

    Science.gov (United States)

    ... QUESTIONS LABOR, DELIVERY, AND POSTPARTUM CARE FAQ006 Cesarean Birth (C-section) • What is cesarean birth? • What are the reasons for cesarean birth? • Is a cesarean birth necessary if I have ...

  16. Using Amniotic Membrane as Wound Covering After Cesarean Section Operation

    International Nuclear Information System (INIS)

    Manjas, Menkher; Helmi, Helfial

    2002-01-01

    Early mobilization and good wound operation healing are the other aim of all treatment for cesarean section operation. Especially for wound healing we can use amniotic membrane which is soft, easy to shape wound surface, satisfactory adhesive properties, good elasticity and sufficient transparency which allows wound control without secondary redressing. From July 1999 until December 1999 total of 196 patients undergoing cesarean section with amnion as would covering were evaluated for injection of amnion, sign of wound injection, and duration of wound healing. Amniotic membrane gives best results in wound healing, no sing of rejection and there is no different results between emergency operation and elective operation, clean and dirty operation

  17. Cimetidine as pre-anesthetic agent for cesarean section

    DEFF Research Database (Denmark)

    Qvist, N; Storm, K; Holmskov, A

    1985-01-01

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

  18. Effect of routine rapid insertion of Bakri balloon tamponade on reducing hemorrhage from placenta previa during and after cesarean section.

    Science.gov (United States)

    Soyama, Hiroaki; Miyamoto, Morikazu; Sasa, Hidenori; Ishibashi, Hiroki; Yoshida, Masashi; Nakatsuka, Masaya; Takano, Masashi; Furuya, Kenichi

    2017-09-01

    To evaluate the effectiveness of routine rapid insertion of a Bakri balloon during cesarean section for placenta previa based on a retrospective control study. Women with singleton pregnancies who underwent cesarean section for placenta previa at our institution between 2003 and 2016 were enrolled. Between 2015 and 2016, women who routinely underwent balloon tamponade during cesarean section were defined as the balloon group. Between 2003 and 2014, women who underwent no hemostatic procedures except balloon tamponade were defined as the non-balloon group. The clinical outcomes of the two groups were retrospectively analyzed. Of the 266 women with placenta previa, 50 were in the balloon group and 216 were in the non-balloon group. The bleeding amounts were significantly smaller in the balloon group than in the non-balloon group: intraoperative bleeding (991 vs. 1250 g, p placenta previa.

  19. Cesarean Section in Morbidly Obese Parturients: Practical Implications and Complications

    Science.gov (United States)

    Machado, Lovina SM

    2012-01-01

    The prevalence of obesity has reached pandemic proportions across nations. Morbid obesity has a dramatic impact on pregnancy outcome. Cesarean section in these women poses many surgical, anesthetic, and logistical challenges. In view of the increased risk of cesarean delivery in morbidly obese women, the practical implications and complications are reviewed in this article. A Medline search was conducted to review the recent relevant articles in english literature on cesarean section in morbidly obese women. The types of incisions and techniques used during cesarean delivery, intra-operative and postpartum complications, anesthetic and logistical issues, maternal morbidity and mortality were reviewed. Morbidly obese women with a body mass index (BMI >40 kg/m2 are at increased risk of pregnancy complications and a significantly increased rate of cesarean delivery. Low transverse skin incisions and transverse uterine incisions are definitely superior and must be the first option. Closure of the subcutaneous layer is recommended, but the placement of subcutaneous drains remains controversial. Thromboprophylaxis adjusted to body weight and prophylactic antibiotics help in reducing postpartum morbidity. Morbidly obese women are at increased risk of postpartum infectious morbidity. Weight reduction in the postpartum period and thereafter must be strongly encouraged for optimal future pregnancy outcomes and well-being. PMID:22393542

  20. Planned cesarean section versus planned vaginal delivery: comparison of lower urinary tract symptoms.

    Science.gov (United States)

    Ekström, Asa; Altman, Daniel; Wiklund, Ingela; Larsson, Christina; Andolf, Ellika

    2008-04-01

    We compared the prevalence and risk of lower urinary tract symptoms in healthy primiparous women in relation to vaginal birth or elective cesarean section 9 months after delivery. We performed a prospective controlled cohort study including 220 women delivered by elective cesarean section and 215 by vaginal birth. All subjects received an identical questionnaire on lower urinary tract symptoms in late pregnancy, at 3 and 9 months postpartum. Two hundred twenty subjects underwent elective cesarean section, and 215 subjects underwent vaginal delivery. After childbirth, the 3-month questionnaire was completed by 389/435 subjects (89%) and the 9-month questionnaire by 376/435 subjects (86%). In the vaginal delivery cohort, all lower urinary tract symptoms increased significantly at 9 months follow-up. When compared to cesarean section, the prevalence of stress urinary incontinence (SUI) after vaginal delivery was significantly increased both at 3 (p delivery was the only obstetrical predictor for SUI [relative risk (RR) 8.9, 95% confidence interval (CI) 1.9-42] and for urinary urgency (RR 7.3 95% CI 1.7-32) at 9 months follow-up. A history of SUI before pregnancy (OR 5.2, 95% CI 1.5-19) and at 3 months follow-up (OR 3.9, 95% CI 1.7-8.5) were independent predictors for SUI at 9 months follow-up. Vaginal delivery is associated with an increased risk for lower urinary tract symptoms 9 months after childbirth when compared to elective cesarean section.

  1. [Pregnancy and delivery in patients with a personal history of cesarean section in Dakar: epidemiological, clinical, therapeutic and prognostic aspects].

    Science.gov (United States)

    Koulimaya-Gombet, Cyr Espérance; Diouf, Abdoul Aziz; Diallo, Moussa; Dia, Anna; Sène, Codou; Moreau, Jean Charles; Diouf, Alassane

    2017-01-01

    The aim of our study was to determine hospitalization rate for vaginal birth after cesarean section in Pikine, to evaluate the quality of the management of pregnant women with previous cesarean section and to determine prognostic factors of the outcome of a trial of scar. We conducted a retrospective study based on medical records and operational protocols of patients who underwent vaginal birth after cesarean section over the period 1 January 2010 - 31 December 2011. We analyzed socio-demographic data, pregnancy follow-up, therapeutic modalities and prognosis. Data were collected and analyzed using Microsoft Office Excel 2007 software and SPSS software 17.0. The frequency of vaginal births after cesarean section was 9.6%. The average age of our patients was 29.4 years. Primiparous women accounted for 54%. Short spacing interval between births was found in 52.6% of cases. Based on the number of cesarean sections, the breakdown was as follows: patients with a history of one previous cesarean section (79.8%), patients with a history of two previous caesarean sections (17.9%) and patients with a history of three previous caesarean sections (2.3%). The number of antenatal consultations performed was greater than or equal to 3 in 79.8% of cases. Patients undergoing evacuation accounted for 54.2% and they were already in labor at the time of admission in 81.7% of cases. Trial of scar was authorized in 177 patients (34.3%) and, at the end of this test, 147 patients (83%) had vaginal birth, of whom 21.7% by vacuum extraction. Cesarean section was performed in 71.4% of cases with 245 emergency cesarean sections and 93 scheduled cesarean sections. A history of vaginal birth was a determining factor in normal delivery (p = 0.0001). There was also a significant relationship between mode of admission and decision to perform a cesarean section (p = 0.0001). Maternal mortality was 0.4%. Perinatal mortality rate was 28.2‰ of live births. We are witnessing a dramatic increase of

  2. Postdischarge surveillance for infection following cesarean section: A prospective cohort study comparing methodologies.

    Science.gov (United States)

    Halwani, Muhammad A; Turnbull, Alison E; Harris, Meredith; Witter, Frank; Perl, Trish M

    2016-04-01

    To assess how enhanced postdischarge telephone follow-up calls would improve case finding for surgical site infection (SSI) surveillance after cesarean section. We conducted a prospective cohort study of all patients who delivered by cesarean section between April 22 and August 22, 2010. In addition to our routine surveillance, using clinical databases and electronic patient records, we also made follow-up calls to the patients at 7, 14, and 30 days postoperation. A standard questionnaire with questions about symptoms of SSI, health-seeking behaviors, and treatment received was administered. Descriptive statistics and univariate analysis were performed to assess the effect of the enhanced surveillance. One hundred ninety-three patients underwent cesarean section during this study period. Standard surveillance identified 14 infections with telephone follow-ups identifying an additional 5 infections. Using the call as a gold standard, the sensitivity of the standard methodology to capture SSI was 73.3%. The duration of the calls ranged from 1 to 5 minutes and were well received by the patients. Results suggest that follow-up telephone calls to patients following cesarean section identifies 26.3% of the total SSIs. Enhanced surveillance can provide more informed data to enhance performance and avoid underestimation of rates. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  3. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China.

    Science.gov (United States)

    Gong, Shi-Peng; Guo, Hong-Xia; Zhou, Hong-Zhen; Chen, Li; Yu, Yan-Hong

    2012-03-01

    To estimate the incidence of and identify the risk factors for a surgical site infection after a cesarean section. A survey of women who underwent a cesarean section was conducted in eight hospitals in Guangdong Province, China. The rate of surgical site infection was estimated and a nested case control study was then carried out to identify the risk factors. Among 13 798 women surveyed, 96 (0.7%) developed a surgical site infection after a cesarean section. Multivariate logistic regression analysis identified six factors independently associated with an increased risk of surgical site infection, which included obesity, premature rupture of membranes, lower preoperative hemoglobin, prolonged surgery, lack of prophylactic antibiotics and excessive anal examinations performed during hospitalization. Surgical site infection occurs in approximately 0.7% of cesarean section cases in the general obstetric population in China. Obesity, premature rupture of membranes, lower preoperative hemoglobin, prolonged surgery, lack of prophylactic antibiotics and excessive anal examinations during hospitalization are considered to be independent risk factors. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.

  4. Non-obstructive cecal dilatation and perforation after cesarean section

    DEFF Research Database (Denmark)

    Sperling, Lene; Schantz, A L; Toftager-Larsen, K

    1990-01-01

    A case of non-obstructive cecal dilatation and perforation after cesarean section is reported, with a review of the literature on the diagnosis and management of this entity. Fifteen cases have been described. Attention is called to this rare complication and to the accompanying pseudo...

  5. Delivery by Cesarean Section and risk of childhood cancer

    DEFF Research Database (Denmark)

    Momen, Natalie; Olsen, Jørn; Gissler, Mika

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

  6. Niches after cesarean section in a population seeking hysteroscopic sterilization

    NARCIS (Netherlands)

    van der Voet, Lucy Lucet F.; Limperg, Tobias; Veersema, Sebastiaan; Timmermans, Anne; Bij de Vaate, A. Marjolein J.; Brölmann, Hans A. M.; Huirne, Judith A. F.

    2017-01-01

    Objective: To study the prevalence of hysteroscopically evaluated disruptions of the integrity of the uterine wall ('niches') in women with and without a previous cesarean section. Study design: A prospective cohort study was performed in a teaching hospital in the Netherlands. Women seeking

  7. Niches after cesarean section in a population seeking hysteroscopic sterilization

    NARCIS (Netherlands)

    Voet, Lucy Lucet F van der; Limperg, Tobias; Veersema, Sebastiaan; Timmermans, Anne M.; Bij de Vaate, A. Marjolein J.; Brölmann, Hans A M; Huirne, Judith A F

    2017-01-01

    Objective To study the prevalence of hysteroscopically evaluated disruptions of the integrity of the uterine wall (‘niches’) in women with and without a previous cesarean section. Study design A prospective cohort study was performed in a teaching hospital in the Netherlands. Women seeking

  8. [Ogilvie syndrome after cesarean section. A clinical contribution].

    Science.gov (United States)

    Vitale, G; Mancuso, P; Linciano, M; Binotto, F; Tinti, S; Torresin, L; Ferrari, P

    1990-03-01

    Following the observation of a case of acute pseudo-obstruction of the colon (Ogilvie's syndrome) after cesarean section, the Authors describe their clinical experience in relation to recently published reports. While discussing other features of the syndrome, the importance of radiological monitoring of the colonic stasis and the validity of perendoscopic decompression of the colon as an efficacious therapy are underlined.

  9. Cesarean section and disease associated with immune function

    DEFF Research Database (Denmark)

    Kristensen, Kim; Henriksen, Lonny

    2016-01-01

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

  10. Surgical-site Infection Following Cesarean Section in Kano, Nigeria ...

    African Journals Online (AJOL)

    Objectives: To determine the prevalence, risk factors and common bacterial pathogens for surgical site infection (SSI), following cesarean section (CS). Materials and Methods: A retrospective case-control study of patients delivered by CS in Aminu Kano Teaching Hospital, Kano, Nigeria. The cases were the patients whose ...

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

    International Nuclear Information System (INIS)

    Dicle, O.; Kuecuekler, C.; Pirnar, T.; Erata, Y.; Posaci, C.

    1997-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1997-02-01

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

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

    DEFF Research Database (Denmark)

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

    1994-01-01

    Three methods of skin closure after cesarean section were tested and compared in a prospective trial. Eighty-nine (82.5%) appeared for follow-up investigation 4-5 months after delivery. The mean scar width was significantly narrower after phannenstiel incision compared with percutaneous nylon...

  14. Comparison of indications for cesarean section in Zaria, Nigeria ...

    African Journals Online (AJOL)

    Background: Cesarean section (CS) rates and indications give a reflection of the maternal health status in the environment. This study was carried out to compare the CS rates and indications in this unit in 1985 and 1995, with a view to determining changes in the health seeking behaviour and possibly maternal health of ...

  15. Pregnant Nigerian women's view of cesarean section | Sunday ...

    African Journals Online (AJOL)

    Abstract. Objective: Cesarean section (C/S) is still being perceived as an abnormal means of delivery by many antenatal women in Nigeria. This study aims to determine the perceptions of antenatal clients in the southeastern Nigeria on C/S. Materials and Methods: The study was conducted using a structured questionnaire ...

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

    OpenAIRE

    Liping Zhou; Zubeir TS; Hamida SA

    2013-01-01

    Objective: To explore and analyze the indications and causes of cesarean section on Pemba island of Zanzibar in Africa to improve the quality of obstetrics. Methods: 564 patients performed cesarean section in Abdulla Mzee Hospital of Pemba from January, 2008 to December, 2011 were selected, and statistics was conducted by the method of retrospective analysis. Results: The rate of cesarean section in Abdulla Mzee Hospital of Pemba was 10.01%. The primary causes of cesarean section included cep...

  17. 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...... and 2010. Exclusion criteria were diabetes, two prior cesarean sections, index cesarean at a different hospital, a delivery after the index cesarean, twin gestation, gestational age ... 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...

  18. [The outcome of trial of labor after cesarean section].

    Science.gov (United States)

    Qu, Z Q; Ma, R M; Xiao, H; Tian, Y Q; Li, B L; Liang, K; Du, M Y; Chen, Z; Geng, L; Yang, M H; Tao, Y P; Zhu, B

    2016-10-25

    Objective: To explore the outcome of trial of labor after cesarean section(TOLAC). Methods: Totally 614 TOLAC were conducted in the First Affiliated Hospital of Kunming Medical University from July 2013 to June 2016. Among them, 586 cases of singleton pregnancy with one prior cesarean section(gestational age≥28 weeks)were studied retrospectively. The maternal and neonatal outcomes among the vaginal birth after cesarean(VBAC)group(481 cases), failed TOLAC group(105 cases)and the elective repeat cesarean section(ERCS)group(1 145 cases)were compared. Multiple logistic regression was used to determine the risk factors of admission to neonatal intensive care unit(NICU). Results: (1)The TOLAC rate was 29.62%(614/2 073)from July 2013 to June 2016, and the VBAC rate was 82.6%(507/614). The cesarean section rate was reduced by VBAC by 3.147%(507/16 112).(2)The comparison of adverse maternal outcomes: in the VBAC group, the postpartum hemorrhage volume was(431±299)ml, the rate of postpartum fever was 6.4%(31/481), the birth weight of the neonates was(3 085± 561)g, and the rate of large for gestational age was 2.9%(14/481). All were significantly lower than those in the failed TOLAC group and the ERCS group( P 0.05). Multiple logistic regression showed no association between VBAC and admission to the NICU( OR =0.84, 95% CI : 0.58-1.21). The isolated risk factors for admission to the NICU were preterm birth( OR =16.71, 95% CI : 11.44-24.40), hypertensive disorder complicating pregnamcy( OR =3.89, 95% CI : 2.39-6.35), meconium stained amniotic fluid( OR =2.48, 95% CI : 1.62-3.80), small for gestational age( OR =2.00, 95% CI : 1.19-3.36)and diabetes mellitus( OR =1.69, 95% CI : 1.14-2.50). Conclusions: VBAC reduces cesarean section rate, with good outcomes in both mother and neonate. It is a safe and feasible way of labor in women with only one cesarean section history.

  19. Anesthesia for cesarean section in pregnancies complicated by placenta previa

    International Nuclear Information System (INIS)

    Imarengiaye, Charles O.; Osaigbovo, Etinosa P.; Tudjegbe, Sampson O.

    2008-01-01

    Objective was to evaluate the factors affecting the choice of anesthetic technique for cesarean section in women with placenta previa. In this retrospective study, the records of the labor Ward Theatre of the University of Benin Teaching Hospital, Benin City, Nigeria were examined from January 2000 to December 2004 to identify all the women who had cesarean section for placenta previa. The patient's socio-demographic characteristics, type of placenta previa, anesthesia technique, estimated blood loss, maternal and fetal outcomes were recorded. One hundred and twenty-six patients had cesarean section for placenta previa, however, only 81 patients 64.3% were available for analysis. General anesthesia was administered to 52/81 patients 64.2% and 29/81 patients 35.8% received spinal anesthesia. A history of antepartum bleeding was recorded in 61.7% n=50. Of 31 patients without antepartum hemorrhage APH, 15/31 had general anesthesia and 16/31 had spinal anesthesia. The patients who had APH, 37/50 had general anesthesia and 1/50 had spinal anesthesia. There was an increased chance of using general anesthesia and if APH were present p=0.03, odds ratio=3.1, 95% confidence interval=1.2-7.7. Spinal anesthesia may useful in patients with placenta previa. The presence of APH may encourage the use of general anesthesia for cesarean delivery. (author)

  20. Variation in cesarean section rates is not related to maternal and neonatal outcomes.

    Science.gov (United States)

    Pallasmaa, Nanneli; Alanen, Anna; Ekblad, Ulla; Vahlberg, Tero; Koivisto, Mari; Raudaskoski, Tytti; Ulander, Veli-Matti; Uotila, Jukka

    2013-10-01

    The aim of this study was to compare the rate of cesarean sections in 12 delivery units in Finland, and to assess possible associations between cesarean section rates and maternal and neonatal complications. Prospective multicenter cohort study. The 12 largest delivery units in Finland. Total obstetric population between 1 January 2005 and 30 June 2005 (n = 19 764). Prospectively collected data on 2496 cesarean sections and data derived from the Finnish Birth Register on all deliveries in these units were compared. Cesarean section rates and maternal complication rates were adjusted for known risk factors. Cesarean section rate, maternal complications related to cesarean section, and neonatal asphyxia. The cesarean section rates varied significantly between the hospitals (12.9-25.1%, p complication rates related to cesarean section (13.0-36.5%, p complications and the cesarean section rate. The differences remained after adjusting for risk factors. Neonatal asphyxia rates varied between 0.14 and 2.8% (p cesarean section rates. The rates of cesarean section, maternal complications and neonatal asphyxia vary markedly between different delivery units. Good maternal and neonatal outcomes can be achieved with cesarean section rates <15%. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

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

    NARCIS (Netherlands)

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

    2007-01-01

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

  2. The analysis of the causes of uterine bleeding occurred after cesarean section and the evaluation of interventional therapy for bleeding

    International Nuclear Information System (INIS)

    Hu Peng; Li Yuwei; Li Yunhui; Luo Bin; Wen Wen; Yang Bo

    2011-01-01

    Objective: to analyze the causes of uterine hemorrhage occurred after cesarean section and to investigate the value of angiography and transcatheter artery embolization (TAE) in the diagnosis and treatment of postpartum hemorrhage after cesarean section. Methods: During the period from Jan. 2001 to Dec. 2011, a total of 65 cases suffering from uterine bleeding after cesarean section had underwent uterine arteriography to clarify the diagnosis, which was followed by transcatheter uterine artery embolization (TUAE). The clinical data, the causes of bleeding and the angiographic features were retrospectively analyzed. Results: The causes of uterine bleeding after cesarean section included uterine artery pseudoaneurysm (n=26), uterine atony (n=18), placental factors (n=11), gestational hypertension (n=8), coexisting uterine fibroids (n=1) and uterine bleeding of unknown reason (n=1). Uterine artery angiography revealed contrast extravasation in all patients except one patient. The angiographic findings confirmed the diagnosis of uterine artery bleeding after cesarean section. The bleeding stopped after TUAE, and the patients were in stable condition. No serious complications occurred. Conclusion: Pseudoaneurysm is the primary cause of postpartum uterine hemorrhage after cesarean section. Transcatheter uterine artery angiography can promptly and reliably determine the causes of bleeding, and, at the same time, embolization therapy can be carried out to effectively stop the bleeding. (authors)

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

    Science.gov (United States)

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

    2016-05-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  5. [Factors associated with successful vaginal birth in women with a cesarean section history].

    Science.gov (United States)

    Sepúlveda-Mendoza, Denisse Lorena; Galván-Caudillo, Marisol; Soto-Fuenzalida, Gonzalo Andrés; Méndez-Lozano, Daniel Humberto

    2015-12-01

    BAKCGROUND: Caesarean section is the main proceedings for ending of pregnancy in the world, and currently represents a public health problem. Some factors that benefit the likelihood of vaginal birth after a previous C-section have been described in literature, with scoring tools designed to predict success for trial of labor after a previous cesarean. There are few studies that identify predictors of success for vaginal delivery in Latin-American patients. To identify predictive factors associated to vaginal delivery success in patients with a prior cesarean delivery. Case-control study. We included patients with one previous cesarean delivery admitted at our hospital. The variables analyzed with a logistic regression system to predict vaginal delivery success probabilities. A total of 11 60 patients were included, 668 underwent C-section (considered control group), and 492 patients had a vaginal delivery (considered study group). The Factors associated to vaginal birth after cesarean delivery were maternal age (25.1±5.4 vs 24.7±5.5 years old, OR 0.967, p<0.05), fetal weight (3,253±389 vs 3,383±452 g, OR 0.99, p<0.05), previous vaginal delivery (49 vs 1 8.4%, OR 2.97, p<0.05) and spontaneous labor (90.8 vs 74.1%, OR 3.68, p<0.05, respectively). Maternal age, fetal weight, previous vaginal delivery and spontaneous labor were associated with vaginal delivery success in patients with a previous cesarean delivery.

  6. Chronic subdural hematoma following spinal anesthesia for cesarean section.

    Science.gov (United States)

    Metin, Kübra Mehel; Güzel, Is Il; Oskovi, Aslı; Guzel, Ali Irfan

    2017-09-01

    Intracranial subdural hematoma after spinal anesthesia is a rare and life-threatening complication of spinal anesthesia. The most common complication of spinal anesthesia is the postdural puncture headache. When severe and persistent headache after spinal anesthesia occur, differential diagnosis can be explored. In this report, we aimed to evaluate a patient with persistent headache following spinal anesthesia for cesarean section in a 31-year-old woman ,and emphasize a rare complication of spinal anesthesia which is subdural hematoma.

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

    Energy Technology Data Exchange (ETDEWEB)

    Lysack, John T.; Soboleski, Don [Department of Diagnostic Radiology, Queen' s University, Kingston General Hospital, 76 Stuart Street, K7L 2V7, Kingston, Ont. (Canada)

    2003-06-01

    We report a case of an otherwise healthy neonate diagnosed at birth with a classic metaphyseal lesion of the proximal tibia following external cephalic version for frank breech presentation and a subsequent urgent cesarean section. Although the classic metaphyseal lesion is considered highly specific for infant abuse, this case demonstrates the importance of obtaining a history of obstetric trauma for neonates presenting to the imaging department for suspected non-accidental injury. (orig.)

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

    International Nuclear Information System (INIS)

    Lysack, John T.; Soboleski, Don

    2003-01-01

    We report a case of an otherwise healthy neonate diagnosed at birth with a classic metaphyseal lesion of the proximal tibia following external cephalic version for frank breech presentation and a subsequent urgent cesarean section. Although the classic metaphyseal lesion is considered highly specific for infant abuse, this case demonstrates the importance of obtaining a history of obstetric trauma for neonates presenting to the imaging department for suspected non-accidental injury. (orig.)

  9. Rates and trends in cesarean sections between 2008 and 2012 in Iraq.

    Science.gov (United States)

    Shabila, Nazar P

    2017-01-11

    The prevalence of cesarean sections is increasing globally; however, it can lead to significant increases in maternal and infant morbidity and mortality. This study aimed to determine the rates and trends of cesarean sections in Iraq. The cesarean section rates of all births and public and private hospital-based births were calculated from the data on births provided by the annual reports of the Iraqi Ministry of Health for the years 2008 and 2012. The comparable rates for the Center/South and Kurdistan Region and the individual governorates were determined. The cesarean section rates for all births in 2008 were computed and compared with the 2012 rates. The cesarean section rate for all births in Iraq was 24.4% in 2012, which was similar to the rates in the Iraqi Kurdistan Region (25.4%) and the Center/South of Iraq (24.3%). The cesarean section rates were specifically high in the governorates containing a larger number of private hospitals, and there was a significant positive relationship between the number of private hospitals and the cesarean section rate (beta = 0.671; r = 0.671; P rate was 34.7%. The cesarean section rate in private hospitals (77.9%) was remarkably higher than the rate in public hospitals (29.3%). The overall rate of cesarean sections in Iraq increased from 18.0% in 2008 to 24.4% in 2012. The cesarean section rate in Iraq is far above the recommended rate. Iraq witnessed a rapid upward trend in the cesarean section rate from 2008 to 2012, with most of this trend attributable to the Kurdistan Region. There is a potential relationship between the expansion of the private health sector and the increasing cesarean section rate, and further studies of this relationship are necessary. Future research should consider an audit of the indications for a cesarean section rather than measuring the cesarean section rate alone.

  10. Estudo clínico e cardiorrespiratório em cadelas gestantes com parto normal ou submetidas à cesariana sob anestesia inalatória com sevofluorano Clinical and cardiorespiratory study in bitches under normal parturition or underwent to cesarean section using inalatory anesthesia with sevoflurane

    Directory of Open Access Journals (Sweden)

    D.T. Gabas

    2006-08-01

    temperature and invasive arterial blood pressure throughout the anaesthetic period, besides the anaesthetic recovery quality. The bitches, submitted to the caesarean sections showed lower values of cardiac frequency, arterial pressure, respiratory frequency, time of capilar reperfusion and arterial blood pH when compared to the bitches which underwent natural birth, showing the cardiorespiratoy depression induced by the anaesthetic procedure. In spite of the anaesthetic depression, the anaesthetic protocol employed had no effect on the viability and health of the bitches and the puppies, and can be safely recommend for caesarean sections.

  11. Usefulness of pelvic artery embolization in cesarean section compared with vaginal delivery in 176 patients.

    Science.gov (United States)

    Lee, Hyun Joo; Jeon, Gyeong Sik; Kim, Man Deuk; Kim, Sang Heum; Lee, Jong Tae; Choi, Min Jeong

    2013-01-01

    To evaluate the efficacy and safety of transcatheter arterial embolization of the pelvic arteries for the treatment of postpartum hemorrhage (PPH) associated with cesarean section compared with vaginal delivery. A retrospective analysis of 176 patients undergoing transcatheter arterial embolization of the pelvic arteries for PPH from January 2006 through August 2011 was conducted at two institutions. The mean patient age was 33.9 years (range, 24-46 years). Data including delivery details, hematology and coagulation results, embolization details, and clinical outcomes were collected. Technical success was defined as cessation of bleeding on angiography or angiographically successful embolization of the bleeding artery. Clinical success was defined as the obviation of repeated embolization or surgical intervention. The technical success rate was 98.8% (n = 174), and the clinical success rate was 89.7% (n = 158). Among 176 patients, 71 had cesarean sections, and 105 underwent normal vaginal deliveries. Of the 105 patients who underwent normal vaginal deliveries, 11 (10.5%) required repeat embolization or surgical intervention. Of the 71 patients who had cesarean sections, 7 (9.8%) required repeat embolization or surgical intervention. The clinical success rate and complication rate were not related to the mode of delivery. All women resumed menses after transcatheter arterial embolization, and most (n = 125) described their menses as unchanged. Subsequent spontaneous pregnancies occurred in 13 women. The cesarean mode of delivery is not a predictor of poorer outcomes of transcatheter arterial embolization; however, further study is needed to clarify this relationship. Copyright © 2013 SIR. Published by Elsevier Inc. All rights reserved.

  12. Longer travel time to district hospital worsens neonatal outcomes: a retrospective cross-sectional study of the effect of delays in receiving emergency cesarean section in Rwanda.

    Science.gov (United States)

    Niyitegeka, Joseph; Nshimirimana, Georges; Silverstein, Allison; Odhiambo, Jackline; Lin, Yihan; Nkurunziza, Theoneste; Riviello, Robert; Rulisa, Stephen; Banguti, Paulin; Magge, Hema; Macharia, Martin; Habimana, Regis; Hedt-Gauthier, Bethany

    2017-07-25

    In low-resource settings, access to emergency cesarean section is associated with various delays leading to poor neonatal outcomes. In this study, we described the delays a mother faces when needing emergency cesarean delivery and assessed the effect of these delays on neonatal outcomes in Rwanda. This retrospective study included 441 neonates and their mothers who underwent emergency cesarean section in 2015 at three district hospitals in Rwanda. Four delays were measured: duration of labor prior to hospital admission, travel time from health center to district hospital, time from admission to surgical incision, and time from decision for emergency cesarean section to surgical incision. Neonatal outcomes were categorized as unfavorable (APGAR cesarean sections started within 5 h after hospital admission and 85.2% (288 of 338) started more than 30 min after the decision for cesarean section was made. Neonatal outcomes were significantly worse among mothers with more than 90 min of travel time from the health center to the district hospital compared to mothers referred from health centers located on the same compound as the hospital (aOR = 5.12, p = 0.02). Neonates with cesarean deliveries starting more than 30 min after decision for cesarean section had better outcomes than those starting immediately (aOR = 0.32, p = 0.04). Longer travel time between health center and district hospital was associated with poor neonatal outcomes, highlighting a need to decrease barriers to accessing emergency maternal services. However, longer decision to incision interval posed less risk for adverse neonatal outcome. While this could indicate thorough pre-operative interventions including triage and resuscitation, this relationship should be studied prospectively in the future.

  13. The effect of small dose bupivacaine-fentanyl in spinal anesthesia on hemodynamic nausea and vomiting in cesarean section

    International Nuclear Information System (INIS)

    Seyedhejazi, M.; Madarek, E.

    2007-01-01

    To compare the hemodynamic, nausea and vomiting with small dose bupivacaine-fentanyl spinal anesthetic versus a conventional dose of spinal bupivacaine in parturients undergoing cesarean section. Forty patients aged 17-35 years old which underwent cesarean section were randomized into two groups. Group-A received spinal anesthesia with 8 mg of bupivacaine and 10 microg fentanyl, group B received 12 mg bupivacaine. The mean dose of ephedrine needed was 4mg in group A and 11.75 mg in group B (P=0.006). The mean ratio of lowest systolic pressure to baseline systolic pressure was 0.75 for group A and 0.65 for group B (P=0.04). Nausea and vomiting was observed in 10% of group A versus 20% in group B. Small dose of bupivacaine and fentanyl provides good spinal anesthesia for cesarean section with less hypotension, nausea and vomiting. (author)

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

    Science.gov (United States)

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

    2015-03-01

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

  15. A suspected case of rocuronium-sugammadex complex-induced anaphylactic shock after cesarean section.

    Science.gov (United States)

    Yamaoka, Masakazu; Deguchi, Miki; Ninomiya, Kiichiro; Kurasako, Toshiaki; Matsumoto, Mutsuko

    2017-02-01

    An anaphylactic reaction during a cesarean section occurs rarely, and rocuronium is thought to be one of the common agents causing perioperative anaphylaxis. Here we report an anaphylactic shock after cesarean section that is suggested to be induced by the rocuronium-sugammadex complex. A 36-year-old primigravida underwent an elective cesarean section under general anesthesia due to placenta previa. While the operation was completed uneventfully, she developed anaphylactic shock following sugammadex administration. She was successfully managed with rapid treatments. Serum tryptase level was significantly elevated. Although sugammadex was first suspected to be the causative agent, the result of intradermal skin tests with sugammadex were negative. Surprisingly, a subsequent intradermal test with undiluted rocuronium caused the patient to fall into a state of shock. Furthermore, a later skin-prick test with pre-mixed rocuronium-sugammadex complex also revealed a strong positive reaction, and a test with only rocuronium showed negative. We finally concluded that the rocuronium-sugammadex complex is the causative agent in this case. To the best of our knowledge, this is the first report suggesting anaphylaxis caused by the rocuronium-sugammadex complex. This case highlights the importance of appropriate examinations to determinate the pathogenesis of anaphylaxis in order to establish risk reduction strategies.

  16. [Rupture of the uterus as a complication in delivery after cesarean section].

    Science.gov (United States)

    Fatusić, Zlantan; Grgić, Gordana; Musić, Asim; Hudić, Igor

    2005-01-01

    In present clinical practice there is an increasing number of patients with delivery with previous cesarean section which is frequent reason for the repeated one. The most serious complication in labour with previous cesarean section is the rupture of the uterus which is as frequent in labour by natural way as in repeated cesarean section. This is a reason that many of obstetricians do not support attitude "Once cesarean section, always a cesarean". In a retrospective study in five years period beginning January 1, 1998, we analyzed total number of deliveries, total number of cesarean section, way of deliveries with previous cesarean section and frequency of complications. We used Chi2 test and Contigency table. In analyzed period from January 1, 1998 through December 31, 2002, we completed 24,194 deliveries at Ob/Gyn Clinic in Tuzla. Out of this number we performed 4073 cesarean sections or 16.83%. Out of 24,194 deliveries we had 1328 (5.49% of all deliveries) deliveries after performed cesarean in previous pregnancy. Out of 1328 deliveries following cesarean we completed by natural way 323 pregnancies or 24.33% and by repeated cesarean 1005 or 75.67%. Previous one cesarean had 1191, previous two cesarean 126, and previous three cesarean had 11 women. Out of 1328 deliveries by previous cesarean we had 12 (0.90%) or 1:111 cases, complicated by intrapartum rupture of the uterus. It was significantly more than in group of deliveries by unscarred uterus (1:16,849 deliveries). Three of 12 ruptures of the uterus were in group by natural way of delivery and 9 cases in group by repeated cesarean, no statistical difference (p>0.05). Out of 12 cases complicated by rupture of the uterus, ten cases were incomplete and two complete rupture of the uterus. Repeated cesarean section by his complications imposes the careful choice of indication for primary cesarean section and by this way make maternal mortality and morbidity significantly lower, specially in the light of the fact

  17. Anesthesia for cesarean section on a pregnant woman with hypoplasia of the distal aorta. Case report.

    Science.gov (United States)

    de Reis, Leonardo Andrade; dos Reis, Guilherme Frederico Ferreira; Colombano, Rodrigo Dias

    2008-01-01

    Maternal vascular anomalies, potentially severe for the fetus, can jeopardize uterine perfusion, which demands more caution by the anesthesiology team. The objective of this report was to demonstrate the anesthetic conduct for a cesarean section on a pregnant woman with hipoplasia of the distal aorta, just below the renal arteries, with stenosis of the renal artery and absence of the iliac arteries. This is a 30-year old patient, weighing 54 kg, on her second pregnancy, with a history of an uncomplicated cesarean section. During the gestational echocardiography on the 12th week, it was observed an interruption of the distal aorta, just below the renal arteries. The patient was referred for coronary angiography, which demonstrated hypoplasia of the distal aorta, just below the renal arteries, and absence of the iliac arteries. During the clinical investigation, the patient remained asymptomatic, except for hypertension and claudication during great efforts. She underwent continuous epidural anesthesia and the dose of the anesthetic was titrated as needed for the cesarean section. Initially, 50 mg of 0.5% bupivacaine without vasoconstrictor and 10 microg of sufentanil were administered. After 15 minutes, anesthesia was complemented with 25 mg of 0.5% bupivacaine, which was enough to achieve an adequate level of blockade. The cesarean section was performed without intercurrences, and the fetus was born in good clinical conditions. The use of continuous epidural block in fractionated doses demonstrated to be a safe anesthetic technique for this procedure because it reduces the risks of maternal hypotension, inherent to the spinal block, and also minimized the placentary transference of drugs, which is the case with general anesthesia. Titration of drugs through the epidural catheter allowed reaching an adequate anesthetic level for this type of surgery.

  18. [Cesarean section incidence and vaginal birth success rate at term pregnancy after myomectomy].

    Science.gov (United States)

    Mekiňová, L; Janků, P; Filipinská, E; Kadlecová, J; Ventruba, P

    To compare the incidence of primary and acute cesarean section (CS) and to compare success rate of vaginal delivery. To determine the frequency of maternal complications and evaluation of post-partum condition of the newborn. Prospective, pilot, cohort study. Department of Gynecology and Obstetrics Masaryk University and University Hospital Brno. Analysis of patients with physiologically ongoing singleton pregnancy and term delivery, vertex presentation. Women from the study group (n = 67) underwent myomectomy because of symptomatic, solitary uterine fibroid. Women from the control group (n = 4079) had no history of myomectomy. Analysis was aimed at comparing the incidence of primary and acute CS and comparing success rate of vaginal delivery in both groups and determing the frequency of maternal complications and evaluation of post-partum condition of the newborn. A significantly higher incidence of primary cesarean section was observed in the study group with a history of myomectomy compared to the control group (n = 20, 29.9%; versus n = 396, 9.7 %, p cesarean section in both groups was recorded (n = 7, 10.4%; versus n = 570, 14.0%, p = 0.079). No statistically significant difference in the success of vaginal delivery in both groups was recorded (n = 40, 85.1%; versus n = 3113, 84.5%, p = 0.079). The excessive blood loss was the most frequent complication in both group (n = 9, 13.4%; versus n = 214, 5.2%, p = 0.057). No statistically significant difference in the incidence of uterine rupture and postpartum hysterectomy was recorded. No maternal or fetal death related to childbirth was observed. The history of myomectomy does not increase the incidence of acute cesarean section in the group of strictly selected patients suitable for vaginal birth and has no impact on the success of vaginal delivery. Careful management of labor is a prerequisite for a low risk of maternal complications and good perinatal outcomes.

  19. Incidence and risk factors of surgical site infection following cesarean section at Dhulikhel Hospital.

    Science.gov (United States)

    Shrestha, S; Shrestha, R; Shrestha, B; Dongol, A

    2014-01-01

    Cesarean Section (CS) is one of the most commonly performed surgical procedures in obstetrical and gynecological department. Surgical site infection (SSI) after a cesarean section increases maternal morbidity prolongs hospital stay and medical costs. The aim of this study was to find out the incidence and associated risk factors of surgical site infection among cesarean section cases. A prospective, descriptive study was conducted at Dhulikhel Hospital, department of Obstetrics and Gynaecology from July 2013 to June 2014. Total of 648 women who underwent surgical procedure for delivery during study period were included in the study. Data was collected from patient using structred pro forma and examination of wound till discharge was done. Data was compared in terms of presence of surgical site infection and study variables. Wound was evaluated for the development of SSI on third day, and fifth post-operative day, and on the day of discharge. Total of 648 cases were studied. The mean age was 24±4.18. Among the studied cases 92% were literate and 8% were illiterate. Antenatal clinic was attended by 97.7%. The incidence rate of surgical site infection was 82 (12.6%). SSI was found to be common in women who had rupture of membrane before surgery (p=0.020), who underwent emergency surgery (p=0.0004), and the women who had vertical skin incision (p=0.0001) and interrupted skin suturing (p=0.0001) during surgery. Surgical site infection following caesarean section is common. Various modifiable risk factors were observed in this study. Development of SSI is related to multifactorial rather than one factor. Development and strict implementation of protocol by all the health care professionals could be effective to minimize and prevent the infection rate after caesarean section.

  20. Prevalence and Causes of Cesarean Section in Iran: Systematic Review and Meta-Analysis

    OpenAIRE

    AZAMI-AGHDASH, Saber; GHOJAZADEH, Morteza; DEHDILANI, Nima; MOHAMMADI, Marzieh; ASL AMIN ABAD, Ramin

    2014-01-01

    Abstract Unfortunately, the prevalence of cesarean section has increased in recent years. Whereas awareness of the prevalence and causes is inevitable for planning and effective interventions, so aim of this study has designed and conducted for reviewing of systematic Prevalence and caesarean causes in Iran. In this meta-analysis, the required information have been collected using several keywords which are Cesarean section rate, Cesarean section prevalence, delivery, childhood, childbirth, r...

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Science.gov (United States)

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

    2015-01-01

    Successful vaginal birth after cesarean section is more comfortable than repeat emergency or elective cesarean section. Antenatal examinations are important in selection for trial of labor, while birth management can be difficult when the patients present at emergency condition. But there is an increased chance of vaginal birth with advanced cervical dilation. This study attempts to evaluate factors associated with success of vaginal birth after cesarean section and to compare the maternal and perinatal outcomes between vaginal birth after cesarean section and intrapartum cesarean section in patients who were admitted to hospital during the active or second stage of labor. A retrospective evaluation was made from the results of 127 patients. Cesarean section was performed in 57 patients; 70 attempted trial of labor. The factors associated with success of vaginal birth after cesarean section were investigated. Maternal and neonatal outcomes were compared between the groups. Vaginal birth after cesarean section was successful in 55% of cases. Advanced cervical opening, effacement, gravidity, parity, and prior vaginal delivery were factors associated with successful vaginal birth. The vaginal birth group had more complications (P0.05). In this study, cervical opening, effacement, gravidity, parity, and prior vaginal delivery were important factors for successful vaginal birth after cesarean section. The patients’ requests influenced outcome. Trial of labor should take into consideration the patient’s preference, together with the proper setting. PMID:26203286

  3. Evaluation of cesarean scar after single- and double-layer hysterotomy closure: a prospective cross-sectional study.

    Science.gov (United States)

    Tekiner, Nur Betül; Çetin, Berna Aslan; Türkgeldi, Lale Susan; Yılmaz, Gökçe; Polat, İbrahim; Gedikbaşı, Ali

    2018-05-01

    We aimed to determine if there is a difference in the size of the cesarean scar defect using saline infusion sonography (SIS) performed on the postoperative third month in patients who underwent single- or double-layered unlocked closure of their uterine incision during their first cesarean delivery. This study was conducted as a prospective cross-sectional study between February 2015 and January 2016 in patients admitted to the labour ward of the Kanuni Sultan Suleyman Training and Research Hospital who subsequently underwent their first delivery by cesarean section. Patients with a previous history of cesarean delivery, preterm pregnancies less than 34 gestational weeks, patients lost to follow-up or those who had an IUD inserted after delivery were excluded from the study. Out of the 327 patients who underwent primary cesarean delivery, 280 were included into the study. Patients were divided into two groups according to the single- (n:126) or double-layered (n:156) closure of their uterine incision. The maternal age, height, weight, obstetric and gynecologic histories, medical histories, indications for their cesarean delivery, technique of uterine closure, birth weight of the baby, duration of the cesarean delivery, need for extra suturing and transfusion were recorded. A Saline infusion sonography (SIS) was performed 3 months postoperatively to determine the presence, depth and length of the cesarean scar. The residual myometrial thickness overlying the scar defect and the fundal myometrial thickness were recorded. No difference was detected between the groups with respect to patient characteristics, whether the operation was elective or emergent, the type of anesthesia used, need for extra suturing, incidence of bladder injuries or uterine atony, need for blood transfusions, duration of labour or cervical dilatation and effacement between the two groups. No statistically significant difference was detected between the two groups with respect to the length

  4. Cerebroplacental ratio thresholds measured within two weeks of birth and the risk of Cesarean section for intrapartum fetal compromise and adverse neonatal outcome.

    Science.gov (United States)

    N Bligh, Larissa; Alsolai, Amal A; Greer, Ristan M; Kumar, Sailesh

    2017-06-08

    Prediction of intrapartum fetal compromise in uncomplicated, term pregnancies is a global obstetric challenge. Currently, no widely accepted screening test for this condition exists, although the cerebroplacental ratio (CPR) shows promise. We aimed to prospectively evaluate the screening performance of the CPR 10 th centile for detection of Cesarean section for intrapartum fetal compromise (IFC) and composite adverse neonatal outcome (ANO) in low-risk women from 36 weeks and to determine the best CPR threshold from three previously described in the literature. In a blinded, prospective, observational, cohort study, 483 women with uncomplicated singleton pregnancies underwent fortnightly CPR measurement from 36 weeks to delivery and intrapartum and neonatal outcomes were recorded. The CPR 10 th centile threshold screening test performance was calculated for emergency Cesarean section for IFC and composite ANO, incorporating acidosis at birth, Apgar Cesarean section for IFC and 17.9% had a composite ANO. Sensitivity and specificity for CPR Cesarean section IFC and composite ANO, respectively. Comparing the three CPR thresholds, CPR Cesarean section for IFC area under the receiver operating characteristic curve = 0.72, composite ANO area under the receiver operating characteristic curve = 0.58), although its predictive utility was only fair for Cesarean section for IFC and poor for composite ANO. The CPR 10 th centile may be useful as a component of a risk assessment tool for Cesarean section for IFC in low risk pregnancies at term. This article is protected by copyright. All rights reserved.

  5. Risks and benefits of the skin-to-skin cesarean section - a retrospective cohort study.

    Science.gov (United States)

    Posthuma, Selina; Korteweg, Fleurisca J; van der Ploeg, J Marinus; de Boer, Hans D; Buiter, Hannah D; van der Ham, David P

    2017-01-01

    Comparing maternal and neonatal outcomes after conventional cesarean section (CS) versus a "natural" or "skin-to-skin" cesarean section (SSCS). Retrospective cohort of women who underwent a SSCS (01-2013 until 12-2013) compared to conventional CS (08-2011 to 08-2012). CS before 37 weeks, under general anesthesia and in case of fetal distress were excluded. Main outcome measures were maternal blood loss, post-operative infection and admission; neonatal infection and admission; procedural outcomes. We analyzed 285 (44%) women in the SSCS-group and 365 (56%) in the conventional CS-group. There were no significant differences in surgical site infection (2.1% versus 1.6%; RR 1.1; 95%CI 0.64-2.0), or other maternal outcomes. Fewer neonates born after SSCS were admitted to the pediatric ward (9.5% versus 18%; RR 0.58; 95%CI 0.41-0.80) and fewer neonates had a suspected neonatal infection (2.0% versus 7.3%; RR 0.40; 95%CI 0.19-0.83). No differences were observed for other outcomes. Mean operation time was 4m42s longer in the SSCS-group compared to the conventional CS-group (58m versus 53m; 95%CI 2m44s-6m40s). Mean recovery time was 14m46s shorter (114m versus 129m; 95%CI 3m20s-26m). Adverse maternal and neonatal outcomes were not increased after skin-to-skin cesarean compared to conventional cesarean delivery.

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

    Directory of Open Access Journals (Sweden)

    Chapa HO

    2013-02-01

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

  7. The effects of religion and spirituality on postoperative pain, hemodynamic functioning and anxiety after cesarean section.

    OpenAIRE

    Siavash Beiranvand; Morteza Noparast; Nasrin Eslamizade; Saeed Saeedikia

    2014-01-01

    Spiritual elements play an important role in the recovery process from acute postoperative pain. This study was conducted to assess the effect of pray meditation on postoperative pain reduction and physiologic responds among muslim patients who underwent cesarean surgery under spinal anesthesia. This double-blinded randomized clinical trial study was conducted among muslim patients who underwent cesarean surgery under spinal anesthesia during 2011-2013 at tertiary regional and teaching hospit...

  8. Myomectomy at the time of cesarean delivery.

    Science.gov (United States)

    O' Sullivan, R; Abder, R

    2016-11-01

    Myomectomy at the time of cesarean delivery has been traditionally discouraged. Recent literature has challenged this view. We present two cases of large subserosal fibroids that underwent removal without complication at the time of cesarean delivery. We present two patients that underwent myomectomy at the time of cesarean delivery. Case 1 had a 10 cm subserosal leiomyoma removed without complication at the time of a cesarean section for breech presentation. Case two had a fundal myoma removed without incident at the time of primary cesarean delivery for suspected macrosomia. Myomectomy at the time of cesarean section has been traditionally discouraged. Recent studies have questioned this recommendation and demonstrated no significant increase in peri-operative complications when myomectomy is performed at the time cesarean section. Further, there is added benefit in that a future procedure is avoided. Myomectomy at the time of cesarean delivery is both a safe and reasonable procedure.

  9. Risk factors for incomplete healing of the uterine incision after cesarean section.

    Science.gov (United States)

    Chen, Yan; Han, Ping; Wang, Yi-Jia; Li, Yan-Xia

    2017-08-01

    To analyze related risk factors of post-cesarean scar defects (PCSDs). A retrospective study of full-term women delivered by cesarean with singleton infants at our hospital from April 2014 to December 2015 was performed. 69 cases of diagnosed PCSDs and 107 cases with no PCSD who accepted cesarean were recruited for analysis. Individual medical case and operative report review were retrieved for maternal clinical characteristics analysis. There was no difference in age, gestational age, BMI and baby's weight between the two groups. PCSD group has more cases of anemia, higher neutrophil percentage and more cases of elected cesarean and emergency cesarean than controls (all p cesarean, there were more cases with cervix dilated larger than 3 cm in operation and more cases received cesarean at least one time before. In addition, women with cesarean interval of at least 5 years, women with ultrasonic measured echo longer than 3 cm, women with poor healing in uterine incision, women with retroposition of uterus and women who had intrauterine separation are more prone to develop PCSDs. The occurrence of a defective uterine scar after cesarean section is primarily a by-product of the combination of multiple factors: age ≥30 years, BMI ≥27.30, premature rupture of membranes, elective cesarean section, post-operative anemia, WBC count ≥12.5 × 10 9  g/L and retroposition of uterus. These are high risk factors of PCSDs.

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

    Science.gov (United States)

    Nagy, Sándor

    2014-07-20

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

  11. Laparoendoscopic single-site surgery with hysterectomy in patients with prior cesarean section: comparison of surgical outcomes with bladder dissection techniques.

    Science.gov (United States)

    Jo, Eun Ju; Kim, Tae-Joong; Lee, Yoo-Young; Choi, Chel Hun; Lee, Jeong-Won; Bae, Duk-Soo; Kim, Byoung-Gie

    2013-01-01

    The aim of this study was to compare operative outcomes from 300 patients who underwent laparoendoscopic single-site surgery (LESS) with hysterectomy (H) according to previous cesarean section and to describe the bladder dissection technique in detail. Retrospective cohort study (Canadian task classification II-2). A university hospital, research hospital, and a tertiary care center. In total, 300 LESS-H procedures were performed for benign gynecologic disease, cervical disease, and endometrial disease at Samsung Medical Center in Seoul, Korea, between May 2008 and February 2012. Patients were categorized into 2 groups according to previous cesarean history: the previous cesarean section group (n = 98) and the no history of previous cesarean section group (n = 202). LESS-H with vaginal or lateral approach for bladder dissection. Baseline demographics and clinical characteristics, except for age, were generally the same between the 2 groups. The operative outcomes including operative time, uterine weight, estimated blood loss, hemoglobin change, hospital stay, and transfusion rate were not different between the 2 groups. Adhesiolysis was required more in the previous cesarean section group (p = .002). LESS failure requiring additional trocars occurred more often in the previous cesarean section group (p = .041), but the rates of conversion to laparotomy were not different (p = .327). The overall surgical complication rate except transfusion was 2.67% in this study. Two cases of urologic problems with ureter injury or bladder injury were reported in the previous cesarean section group. In the no previous cesarean section group, there were 2 urologic problems. LESS-H is a feasible procedure with a lateral approach or vaginal approach for bladder dissection, even in patients with previous cesarean section. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

  12. Perinatal outcome of preterm cesarean section in a resource‑limited ...

    African Journals Online (AJOL)

    2014-01-02

    Jan 2, 2014 ... Background: The relationship between perinatal outcome and anesthetic technique for preterm cesarean sections has not been ... in perinatal mortality. Key words: General anesthesia, perinatal-outcome, preterm cesarean section, subarachnoid block ..... Toronto: Mosby Year Book; 1993. p. 2065‑103. 6.

  13. Pregnancy outcomes of repeat cesarean section in Peking Union Medical College Hospital.

    Science.gov (United States)

    Ma, Liang-Kun; Liu, Na; Bian, Xu-Ming; Teng, Li-Rong; Qi, Hong; Gong, Xiao-Ming; Liu, Jun-Tao; Yang, Jian-Qiu

    2009-09-01

    To evaluate the effect of elective repeat cesarean section on the maternal and neonatal outcomes. A retrospective clinic- and hospital-based survey was designed for comparing the maternal and neonatal outcomes of elective repeat cesarean section [RCS group (one previous cesarean section) and MRCS group (two or more previous cesarean sections)] and primary cesarean section (FCS group) at Peking Union Medical College Hospital from January 1998 to December 2007. The incidence of repeat cesarean section increased from 1.26% to 7.32%. The mean gestational age at delivery in RCS group (38.1+/-1.8 weeks) and MRCS group (37.3+/-2.5 weeks) were significantly shorter than that in FCS group (38.9+/-2.1 weeks, all Pcomplication was 33.8% and 33.3% in RCS group and MRCS group respectively, and was significantly higher than that in FCS group (7.9%, P0.05). Repeat cesarean section is associated with more complicated surgery technique and increased frequency of maternal morbidity. However, the incidence of neonatal morbidity is similar to primary cesarean section.

  14. Patient-Initiated Elective Cesarean Section of Nulliparous Women in British Columbia, Canada

    NARCIS (Netherlands)

    Hutton, E.K.; Kornelsen, J.

    2012-01-01

    Background: The proportion of cesarean sections is increasing in Canada overall and in British Columbia in particular. It has been suggested that this increase is partially the result of women requesting the procedure, although the prevalence of patient-initiated elective cesarean section is

  15. Disclosing doubtful indications for emergency cesarean sections in rural hospitals in Tanzania

    DEFF Research Database (Denmark)

    Maaløe, Nanna; Bygbjerg, Ib Christian; Onesmo, Rwakyendela

    2012-01-01

    To investigate in depth to what extent indications for emergency cesarean sections followed evidence-based audit criteria for realistic best practice.......To investigate in depth to what extent indications for emergency cesarean sections followed evidence-based audit criteria for realistic best practice....

  16. Perinatal outcome of preterm cesarean section in a resource-limited ...

    African Journals Online (AJOL)

    Background: The relationship between perinatal outcome and anesthetic technique for preterm cesarean sections has not been explored in South Eastern, Nigeria. Objective: The objective of the following study is to evaluate perinatal outcome in preterm cesarean sections conducted under general anesthesia (GA) and ...

  17. Maternal deaths after elective cesarean section for breech presentation in the Netherlands

    NARCIS (Netherlands)

    Schutte, Joke M.; Steegers, Eric A. P.; Santema, Job G.; Schuitemaker, Nico W. E.; Van Roosmalen, Jos

    2007-01-01

    Background and methods. The cesarean section rate for term singleton breech babies in the Netherlands rose from 57 to 81% after the Term Breech Trial in 2000. The Dutch Maternal Mortality Committee registered and evaluated maternal mortality due to elective cesarean section for breech. Results. Four

  18. Can antenatal classes reduce the rate of cesarean section in southern Italy?

    Science.gov (United States)

    Cantone, Daniela; Pelullo, Concetta Paola; Cancellieri, Mariagrazia; Attena, Francesco

    2017-04-01

    Among European Countries, Italy has the highest rate of cesarean section (36.8%), and in the Campania region this rate reaches 60.0%. We conducted a retrospective cohort study to evaluate whether participation in antenatal classes during pregnancy reduces the rate of cesarean delivery in southern Italy. We selected three local health authorities, with the lowest, the highest, and an intermediate rate of cesarean delivery. The study included 1893 mothers who brought their children for vaccination and were interviewed about their participation in antenatal classes and their obstetric history. The main causes of cesarean section given in the interview were clinical indications (61.0%), previous cesarean section (31.0%) and woman's request (8.0%). When we excluded emergency cesarean delivery, we found a moderate association between participation in antenatal classes and cesarean section reduction (relative risk=1.27; 95% CI=1.08-1.49; in percentage values from 49.3% to 38.8%). Private hospitals and the two local health authorities with higher baseline rates of cesarean section showed an enhanced reduction of these rates. Our paper shows moderate efficacy of antenatal classes, which reduced the occurrence of cesarean section by about 10%. However, the cesarean section rate remained high. As it is possible that different classes have a different level of efficacy, a further study on a standardized model of an antenatal classes is in progress, to assess its efficacy in term of cesarean section reduction, with the purpose of its widespread implementation to the whole region. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  19. Uterine artery embolization, not cesarean section, as an option for termination of pregnancy in placenta previa.

    Science.gov (United States)

    Huang, Lingling; Awale, Reenu; Tang, Hui; Zeng, ZhiShan; Li, FuRong; Chen, Yue

    2015-04-01

    To summarize our experiences in the treatment of labor induction in placenta previa using uterine artery embolization. We retrospectively analyzed the clinical data of seven patients with placenta previa who underwent antepartum uterine artery embolization before vaginal delivery. After antepartum embolization, five patients with placenta previa had successful vaginal deliveries and two cases of placenta previa with accreta underwent emergency hysterectomy. Some complications were reported in this experience. The follow-up study showed that most patients resumed their normal menstruation and some of them were able to conceive. For the management of placenta previa, uterine artery embolization is a minimally invasive technique that helps to avoid cesarean section. The impact on menstruation and fertility is yet to be seen. Copyright © 2015. Published by Elsevier B.V.

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

    DEFF Research Database (Denmark)

    Abildgaard, Helle; Diness, Marie; Nickelsen, Carsten

    2012-01-01

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

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

    OpenAIRE

    Kinay, Tugba; Basarir, Zehra O.; Tuncer, Serap F.; Akpinar, Funda; Kayikcioglu, Fulya; Koc, Sevgi; Karakaya, Jale

    2016-01-01

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

  2. Cesarean section and the manipulation of exact delivery time.

    Science.gov (United States)

    Fabbri, Daniele; Monfardini, Chiara; Castaldini, Ilaria; Protonotari, Adalgisa

    2016-07-01

    Physicians are often alleged responsible for the manipulation of delivery timing. We investigate this issue in a setting that negates the influence of financial incentives on physician's behavior. Working on a sample of women admitted at the onset of labor in a big public hospital in Italy we estimate a model for the exact time of delivery as driven by individual Indication to Cesarean Section (ICS) and covariates. We find that ICS does not affect the day of delivery but leads to a circadian rhythm in the likelihood of delivery. The pattern is consistent with the postponement of high ICS deliveries in the late night\\early morning shift. Our evidence hardly supports the manipulation of timing of births as driven by medical staff's "demand for leisure". Physicians seem to manipulate the exact timing of delivery to reduce exposure to risk factors extant during off-peak periods. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Gianluca Raffaello Damiani

    2014-01-01

    Full Text Available A careful management of hepatic capsular rupture, with massive hemoperitoneum which occurred 14 hours after an emergency cesarean section at 36 weeks of gestation, is meticulously reported. The grade of hepatic involvement varies from minor capsular laceration to extensive parenchymal rupture. Our management involved a combination of surgical interventions and aggressive supportive care. The patient was discharged after 53 days and 4 laparotomies and an unsuccessful attempt of superselective artery embolization. Ultrasound after 40 days from the last surgery showed uniform hepatic parenchyma free of focal lesions. Due to the rarity and the unpredictability nature of this devastating event we believe necessary to report our experience, reinforcing the importance of the postsurgery management.

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

    Directory of Open Access Journals (Sweden)

    Cuilan Li

    2016-01-01

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

  5. [Effect of electric acupoint stimulation on shivering in cesarean section].

    Science.gov (United States)

    Yang, Dai-He; Zhu, Yu-Ling; Huang, Wen; Tang, Lin-Feng; Sun, Yi-Hua

    2013-11-01

    To explore the efficacy of electric acupoint stimulation on shivering in cesarean section. Eighty cases of parturients, under the America Society of Anesthesiologists (ASA) physical status II , were randomized into a transcutaneous electrical acupoint stimulation (TEAS) assisted anesthesia group (group A) and an anesthesia group (group B). Spinal-epidural anesthesia(CSEA) puncture was applied to both groups and 8 mg of 0. 75% bubivacaine was given by spinal injection, the block level was T4 T8. In group A, TEAS was applied before CSEA at paired acupoints-ipsilateral Hegu (LI 4)-Laogong (PC 8) and Sanyinjiao (SP 6)-Zusanli (ST 36) till ending the surgery. The 4 pair of bilateral acupoints were fixed with self-adhesive electrodes and connected with Han's acupoint and nerve stimulator (HANS, LH402H), the frequency was 2 Hz/ 15 Hz, the intensity was 10- 30 mA and the form was densedisperse wave within the patients' tolarance. The heart rate (HR), mean arterial pressure (MAP), oxyhemoglobin saturation (SPO) and shivering degree were recorded before anesthesia (To), 1 min after anesthesia puncture (Ti), 1 min after the delivery (Tz), during abdomen closure (T3) and at the end of surgery (T4). The occurrence rate of shivering was 35. 0% (14/40) in group A, which was lower to 67. 5% (27/40, Pshivering was lighter in group A than that in group B at T2, T3 and T4 (all P0. 05). In group B, the HR was faster at T1, T2, T3 and T4 compared to that at T0 (P0.05); there was no statistical significance of SPO2 in both groups (all P>0.05). TEAS can reduce the occurrence rate of shivering and steady the heart rate in cesarean section.

  6. [Investigation on the approach of delivery after previous cesarean section of Xinjiang Uyghur women].

    Science.gov (United States)

    Ding, Xin; Aimainilezi, Adalaiti; Jin, Yan; Abudula, Wuriguli; Yin, Chenghong

    2014-10-01

    To explore the appropriate approach of delivery after cesarean section of Uyghur women in primary hospitals in Xinjiang Uyghur Autonomous Region. A total of 5 154 women delivered in Luopu County People Hospital, Hetian Prefecture, Xinjiang Uyghur Autonomous Region from January 2011 to December 2012. Among them, 178 Uyghur women had cesarean section history. The interval between the previous cesarean section and this delivery varied from 1 year to 17 years. The number of cases attempting vaginal labor and the indications of the previous cesarean section were recorded. The indications for the second cesarean section were analyzed. The gestational weeks at delivery, blood loss in 2 hours after delivery, neonatal birth weight, newborn asphyxia, the rate of postpartum fever (≥ 38 °C) and hospitalization days were compared between the two approaches of delivery. (1) Among the 178 cases, 119 cases attempted vaginal labor, the rate of attempting vaginal labor was 66.9% (119/178). A total of 113 cases succeeded in vaginal delivery (the vaginal delivery group), with the successful rate of attempting vaginal delivery of 95.0% (113/119), and the successful rate of vaginal delivery was 63.5% (113/178). For those 119 women succeeded in vaginal delivery, the indications of the previous cesarean sections were as following: pregnancy complications (68.1%, 81/119), macrosomia(5.0%, 6/119), dystocia (14.3%, 17/119), pregnancies complicated with other diseases (5.0%, 6/119) and cesarean section on maternal request (7.6%, 9/119). (2) 15 cases in the cesarean section group had postpartum hemorrhage, with the incidence of 13.3% (15/113). The mean total labor time was (507 ± 182) minutes. 6 cases attempting vaginal delivery failed and turned to cesarean section. (3) 59 cases received the second cesarean section (the cesarean section group). The rate of second cesarean section was 33.1% (59/178). The indications of the second cesarean section were as following: contracted pelvis (5%, 3

  7. Surgical site infection and its associated factors following cesarean section: a cross sectional study from a public hospital in Ethiopia.

    Science.gov (United States)

    Gelaw, Kelemu Abebe; Aweke, Amlaku Mulat; Astawesegn, Feleke Hailemichael; Demissie, Birhanu Wondimeneh; Zeleke, Liknaw Bewket

    2017-01-01

    A cesarean section is a surgical procedure in which incisions are made through a woman's abdomen and uterus to deliver her baby. Surgical site infections are a common surgical complication among patients delivered with cesarean section. Further it caused to increase maternal morbidity, stay of hospital and the cost of treatment. Hospital based cross-sectional study was conducted to assess the magnitude of surgical site infection following cesarean Site Infections and its associated factors at Lemlem Karl hospital July 1, 2013 to June 30, 2016. Retrospective card review was done on 384 women who gave birth via cesarean section at Lemlem Karl hospital from July 1, 2013 to June 30, 2016. Systematic sampling technique was used to select patient medical cards. The data were entered by Epi info version 7.2 then analyzed using Statistical Package for Social Sciences windows version 20. Both bivariate and multivariate logistic regression was done to test association between predictors and dependent variables. P value of cesarean section, the magnitude of surgical site infection following cesarean section Infection was 6.8%. The identified independent risk factors for surgical site infections were the duration of labor AOR=3.48; 95%CI (1.25, 9.68), rupture of membrane prior to cesarean section AOR=3.678; 95%CI (1.13, 11.96) and the abdominal midline incision (AOR=5.733; 95%CI (2.05, 16.00). The magnitude of surgical site infection following cesarean section is low compare to other previous studies. The independent associated factors for surgical site infection after cesarean section in this study: Membranes rupture prior to cesarean section, duration of labor and sub umbilical abdominal incision. In addition to ensuring sterile environment and aseptic surgeries, use of WHO surgical safety checklist would appear to be a very important intervention to reduce surgical site infections.

  8. Outcomes of the patients diagnosed incidentally appendicitis during cesarean section.

    Science.gov (United States)

    Kulhan, Mehmet; Kulhan, Nur Gozde; Nayki, Umit; Nayki, Cenk; Ulug, Pasa; Ata, Nahit; Toklucu, Hulya

    2017-01-01

    Appendicitis is the most common condition leading to an intraabdominal operation for a non obstetric problem in pregnancy and diagnosis of appendicitis is complicated by the physiologic and anatomic changes that occur during pregnancy. Although a surgical procedure carries the risk of fetal loss or preterm delivery, delay in diagnosis also increases the risk of complications in both mother and fetus. In this report we present our experience and analyze clinical characteristic and the pregnancy outcomes of appendicitis diagnosed incidentally during cesarean in the third trimester. The study population consisted of 23 pregnant women who were diagnosed incidentally with appendicitis during cesarean at Erzincan University Hospital between 2015 and 2016. Appendectomy was performed on 23 patients during a caesarean section performed for any reason. The mean dia-meter of appendix was 7.82 ± 1.85 mm. The mean operation time was 67.39 ± 18.94 SD and antibiotic therapy was given to all patients. Postoperative complications were noted in 4 (17.4%) patients. Wound infection was seen in 4 (17.4%) patients, the other 19 patients revealed no postoperative complications. The mean of APGAR score of newborns in the postoperative period was 8.26 ± 0.86 SD and no complications were observed in both mothers and newborns. Histopathology of the specimen confirmed acute appendicitis in 23 (100%) cases. Acute appendicitis is a challenging diagnosis in the pregnant patient; however, early surgical intervention should be performed with any suspicion. The type of surgery depends on the surgeon's preference and experience.

  9. Validation of models that predict Cesarean section after induction of labor

    NARCIS (Netherlands)

    Verhoeven, C. J. M.; Oudenaarden, A.; Hermus, M. A. A.; Porath, M. M.; Oei, S. G.; Mol, B. W. J.

    2009-01-01

    Objective Models for the prediction of Cesarean delivery after induction of labor can be used to improve clinical decision-making. The objective of this study was to validate two existing models, published by Peregrine et al. and Rane et al., for the prediction of Cesarean section after induction of

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

    DEFF Research Database (Denmark)

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

    1994-01-01

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

  11. Transcutaneous electrical nerve stimulation (TENS) for pain control after vaginal delivery and cesarean section.

    Science.gov (United States)

    Kayman-Kose, Seda; Arioz, Dagistan Tolga; Toktas, Hasan; Koken, Gulengul; Kanat-Pektas, Mine; Kose, Mesut; Yilmazer, Mehmet

    2014-10-01

    The present study aims to determine the efficiency and reliability of transcutaneous electrical nerve stimulation (TENS) in the management of pain related with uterine contractions after vaginal delivery and the pain related with both abdominal incision uterine contractions after cesarean section. A hundred healthy women who underwent cesarean section under general anesthesia were randomly assigned to the placebo group (Group 1) or the TENS group (Group 2), while 100 women who delivered by vaginal route without episiotomy were randomized into the placebo group (Group 3) or the TENS group (Group 4). The patients in Group 2 had statistically lower visual analog scale (VAS) and verbal numerical scale (VNS) scores than the patients in Group 1 (p TENS (p = 0.006). The need for analgesics at the eighth hour of vaginal delivery was statistically similar in the patients who were treated with TENS and the patients who received placebo (p = 0.830). TENS is an effective, reliable, practical and easily available modality of treatment for postpartum pain.

  12. Ogilvie's Syndrome after Cesarean Section: Case Report in Saudi Arabia and Management Approach.

    Science.gov (United States)

    Elsebay, Lamiaa; Galal, Mariam Ahmed

    2017-01-01

    Acute colonic pseudoobstruction or Ogilvie's syndrome is a rare entity that is characterized by acute dilatation of the colon without any mechanical obstruction. It is usually associated with medical disease or surgery and rarely occurs spontaneously. If not diagnosed early, Ogilvie's syndrome may cause bowel ischemia and perforation. A G7P4+2, 40-year-old woman, who is a known case of gestational diabetes mellitus during her current pregnancy, four previous cesarean sections, two early pregnancy losses at six-week gestation, and hypothyroidism, underwent uncomplicated elective cesarean section, after which she complained of abdominal distention. Ogilvie's syndrome is a rare condition yet of interest to obstetricians, midwifery staff, and general surgeons because its early diagnosis and prompt treatment are the keystones to avoid any subsequent fatal complications. This case report reviews the clinical characteristics, diagnostic methods, and management of Ogilvie's syndrome. Moreover, we suggest a management approach to help in early diagnosis and prompt management to improve the outcome of this potentially serious condition.

  13. Myomectomy during cesarean section and adhesion formation as a long-term postoperative complication.

    Science.gov (United States)

    Turgal, Mert; Ozgu-Erdinc, A Seval; Beksac, Kemal; Ozyuncu, Ozgur; Karaagaoglu, Ergun; Beksac, M Sinan

    2015-06-01

    We aimed to evaluate the incidence and features of postoperative adhesion related complications occurring following myolysis or myomectomy performed during cesarean section (C/S). This cross-sectional study consists of four groups of patients who underwent C/S: group I; myolysis is performed by electric cauterization for small superficial fibroids less than 2 cm. (n: 21), group II; myomectomy is performed for pedunculated fibroids (n: 18), group III; myomectomy is performed for intramural/subserous fibroids less than 5 cm. (n: 23), group IV control group (n: 19) who did not go through myomectomy Repeat C/S is performed to study subjects within 1-5 years. All cases are evaluated in terms of mild to moderate adhesions between omentum and uterus, mild to moderate adnexial area adhesions, mild to moderate incision area adhesions and surgical difficulty due to severe adhesions. The incidence of adhesions of omentum and uterus (p= 0.278), mild to moderate adnexial area adhesions (p = 0.831), mild to moderate incision area adhesions (p= 0.804) were similar between the intervention groups (group I, II, and III) and the controls (group IV). Cesarean myomectomy is a safe procedure and can be performed without significant postoperative adhesion formation.

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

    Directory of Open Access Journals (Sweden)

    Liping Zhou

    2013-03-01

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

  15. [Cesarean section versus vaginal delivery--state-of-the-art paper].

    Science.gov (United States)

    Pomorski, Michał; Woytoń, Robert; Woytoń, Piotr; Kozłowska, Jolanta; Zimmer, Mariusz

    2010-05-01

    The aim of the study was to perform a comparative analysis of complications after vaginal deliveries and cesarean sections and to introduce emotional status of the mother as an indication for a cesarean section. 406 patients after vaginal deliveries and cesarean sections, that took place in the first quarter of 2009, were enrolled into the study. In the studied group of 406 patients, 200 women (49.2%) had cesarean section and 206 women (50.8%) delivered vaginally. In both groups there were no differences in the clinical state of newborns, which were assessed according to the Apgar score, and in umbilical cord blood pH. Hemoglobin concentration evaluated on the second day of puerperium was statistically significantly higher in the group of patients after cesarean section than after vaginal delivery. Episiotomy and laparotomy wound healing complications were observed in 2 (0.97%) and 3 (1.5%) cases, respectively. Due to lack of differences in complication rates between cesarean section and vaginal delivery patients, the emotional status of a pregnant woman should be considered as an indication for cesarean section.

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

    Science.gov (United States)

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

    2017-03-23

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

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

    Directory of Open Access Journals (Sweden)

    Alexandre Faisal-Cury

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

  18. Obstetric and Non-Obstetric Risk Factors for Cesarean Section in Oman

    Directory of Open Access Journals (Sweden)

    Ibrahim Al Busaidi

    2012-11-01

    Full Text Available Objectives: This study aims to explore the risk factors, profiles and neonatal outcomes of Cesarean sections among selected women in Oman.Methods: In this hospital-based case-control study, a total of 500 participants (250 cases who had cesarean section and 250 controls who had spontaneous vaginal delivery, were randomly selected from four hospitals. Cases and controls were matched according to timing and place of delivery.Results: The following predictors were found to be significantly associated with increased risk of cesarean section: a advancing age (above the age of 25 years, OR=1.42; p=0.03, b prior cesarean section (previous cesarean section=1, OR=22.71; p=0.001, c increased body mass index (obesity, OR=2.11; p=0.07, d extremes of neonatal birth weight (neonates birth weight 4.0 kg, OR=7.3; p<0.001, and e prepregnancy diabetes (OR=9.3; p=0.04. On the contrary, increased parity and history of the use of birth spacing methods (OR=0.38; p=0.03 were associated with decreased risk of cesarean section.Conclusion: The study calls for increasing awareness about clinical and public health majors that would lead to prevention of risk factors associated with increased risk of cesarean section such as maintaining normal BMI and prevention of gestational and type 2 diabetes mellitus.

  19. Comparison of maternal outcomes from primary cesarean section during the second compared with first stage of labor by indication for the operation.

    Science.gov (United States)

    Lurie, Samuel; Raz, Nili; Boaz, Mona; Sadan, Oscar; Golan, Abraham

    2014-11-01

    To compare maternal outcomes when cesarean sections were performed in the second stage of labor to those performed in the first stage of labor by indication for the operation. This is a retrospective cohort (n=383) of term parturient women who underwent primary cesarean section during active labor. Cases were drawn from the Obstetrics Department, E. Wolfson Medical Center, a tertiary health care university facility, during a 24 month period. All cases were term singleton pregnancies in vertex presentation following unremarkable pregnancy. Maternal morbidity was assessed. A significantly higher rate of unintentional uterine incision extensions was observed in cesarean sections performed during second stage compared to first stage (17.1% vs. 4.6%, p=0.001). It was higher whenever (at first or second stage) the fetal head was pushed (20.0% vs. 5.4%, p=0.0024). Unintentional uterine incision extensions were significantly more frequent when the cesarean section was performed for non-progressive labor during the second stage compared to first stage (16.1% vs. 3.6%, p=0.0052). Uterine atonia was more frequent among parturient women who underwent cesarean section for non-progressive labor during the first stage compared to second stage (16.7% vs. 4.8%, p=0.0382). Uterine atony during first stage cesarean section and unintentional uterine incision extensions during second stage cesarean section were significantly more frequent when the operation was performed for non-progressive labor. Copyright © 2014. Published by Elsevier Ireland Ltd.

  20. Does an increased cesarean section rate improve neonatal outcome in term pregnancies?

    Science.gov (United States)

    Kupari, Marja; Talola, Nina; Luukkaala, Tiina; Tihtonen, Kati

    2016-07-01

    To clarify whether an increased cesarean section rate improves the short-term neonatal outcome in singleton term pregnancies with cephalic presentation. A retrospective study of institutional data on the mode of delivery and neonatal outcome. The study included two cohorts: 1998-1999 (n = 7437) and 2004-2005 (n = 8505), since the institutional cesarean section rate increased sharply between these cohorts and has remained stable after the latter study period. The caesarean section rate almost doubled from 6.8 to 11.3 % (p cesarean section rate from a low to a moderate does not improve the short-term neonatal outcome in term singleton pregnancies. On the contrary neonatal intensive care unit admissions increased with increasing caesarean section rate. Furthermore it is possible to achieve good neonatal outcome with a low cesarean section rate.

  1. Which Factors Influence the Type of Delivery and Cesarean Section Rate in Women with Gestational Diabetes?

    Science.gov (United States)

    Inocêncio, Gonçalo; Braga, António; Lima, Tânia; Vieira, Bruna; Zulmira, Rosa; Carinhas, Maria; Gonçalves, Joaquim; Silva, Clara

    2015-01-01

    To discover the differences between women with gestational diabetes mellitus (GDM) who delivered vaginally and those who delivered by cesarean section, and to assess the cesarean rate in this group of women. We divided all pregnant women with GDM into 2 groups: those who had vaginal delivery and those who gave birth by cesarean section (retrospective study of 6 years). We evaluated 460 births at term (≥ 37 weeks' gestation), for a total of 240 vaginal births and 220 cesarean births. All occurred in our institution. Of all the variables that were compared between the 2 groups, we found statistically significant differences (p history of macrosomia and gestational age at the time of beginning insulin treatment. Pregnant women with GDM and previous history of macrosomia are more likely to be submitted to cesarean section. Also, the initiation of insulin treatment at an early gestational age is associated with a higher chance of a woman delivering by cesarean section. The cesarean section rate in women with GDM was 47.8%.

  2. [Chemical peritonitis after a bladder lesion during a cesarean section. A case report and literature review].

    Science.gov (United States)

    Castro-Cuenca, Alejandro; Ángel-Muller, Edith; González-Carrillo, Viviana Andrea

    2015-02-01

    This paper reviews the case of a patient who underwent a cesarean surgery and re-entered with an oral way intolerance, postprandial emesis, abdominal pain and clear-fluid exit from surgical wound. After possible bladder injury and secondary chemistry peritonitis, the patient was taken to surgery where the diagnosis was confirmed, and the correction of bladder injury as well as peritoneal lavage were performed, it antibiotic therapy for three days and the patient had satisfactory evolution. Bladder injury is a rare complication of cesarean section with an estimated incidence between 0.0016 and 0.94%; but if it is not diagnosed intraoperative it can trigger a clinical setting of secondary chemical peritonitis, due to secondary irritation of the peritoneum. Chemical peritonitis is among the classification of secondary peritonitis. Within the pathophysiology, the mechanical, chemical or bacterial stimulus generates an inflammatory reaction, with progressive generation of exudate, leukocytes and fibrin deposit, which injure mesothelial cells, disrupt the defense and maintenance of peritoneal homeostasis, triggering serious complications, which can lead to multiple organ failure and death. The chemical peritonitis should be suspected with the clinical setting and the risk factors of recent surgical history and timely management should be instituted properly with correction of the cause, antimicrobial treatment, blood volume therapy and nutritional support, which leads to a favorable outcome for the patient and improves survival with fewer complications.

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

    Science.gov (United States)

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

    2011-06-01

    Pheochromocytoma is a catecholamine-producing tumor but rarely delayingly diagnosed until during pregnancy. We reported a pregnant woman who underwent emergent cesarean section because of intrauterine growth retardation, oligohydramnios, and hypertension. The existence of an undiagnosed pheochromocytoma was suspected by the unusual hemodynamic response to spinal anesthesia, abdominal compressions, and operative stimulus. Hypertensive crisis occurred during the operation and she was sent to the intensive care unit for postoperative care. In the intensive care unit, cardiovascular collapse occurred after nonselective β-adrenergic blockade. Unexpected hypertensive crisis during the perioperative period should alert clinicians to the possibility of a pheochromocytoma. For the treatment of choice, nonselective β-adrenergic blockade should not be used before the α-blockade. Copyright © 2011. Published by Elsevier B.V.

  5. [The effect of breast massage at different time in the early period after cesarean section].

    Science.gov (United States)

    Chu, J Y; Zhang, L; Zhang, Y J; Yang, M J; Li, X W; Sun, L L

    2017-11-06

    Objective: To evaluate the effect of breast massage at different time in the early period on maternal lactation after cesarean section. Methods: 80 women delivered by cesarean section were randomly selected from maternity ward of a hospital in Shandong province during Jan. 2013 to Jan. 2015; which were divided into four groups, with 20 patients in each. Three groups received 3 times of breast massage every 24 hoursbeginning from 2, 12 and 24 h after cesarean section, respectively. The control group didn't receive any breast massage. The starting time and status of lactation were observed and recorded after cesarean section. 5 ml venous blood sample was drawn from each patient respectively at 2 h before cesarean, 6, 12, 24, 48 and 72 h after cesarean to test the level of serum prolactin. The lactation status of each group was compared. Results: The P (50) ( P (25)- P (75)) of starting time of lactation of the three massage groups and control group were 3 (2-6) h, 4 (2-8) h, 4 (3-12) h and 4 (2-12) h, respectively, whose differences showed no statistical significance ( H =3.32, P= 0.345).The number of delivered women with adequate lactation 24 hours after cesarean was 10 in the group who received massage beginning from 2 h after cesarean; while the number was only 2 in the control group. The number of delivered women with adequate lactation 48 hours after cesarean was 18 in the group who received massage beginning from 2 h after cesarean; while the number was 8 in the control group. The differences showed statistical significances ( P values were 0.021 and 0.008, respectively). The serum prolactin level in the group of delivered women who received massage from 2 h after cesarean was separately (195.9±78.5), (176.0±96.5), (216.4±110.0), (190.0±56.8) and (184.8±69.6) μg/L at 2, 12, 24, 48 and 72 h after cesarean, which were significantly higher than those in the control group (which were (128.8±40.6), (127.3±66.8), (162.2±58.8), (145.1±64.7) and (141.7±49

  6. Selection of developmentally competent human oocytes aspirated during cesarean section.

    Science.gov (United States)

    Duarte Alcoba, Diego; Gonsales Valério, Edimárlei; Conzatti, Maiara; Schneider, Júlia; Capp, Edison; von Eye Corleta, Helena; Brum, Ilma Simoni

    2018-03-01

    To evaluate the efficiency/safety of Brilliant Cresyl Blue (BCB) staining as a selection method of developmentally competent immature human oocytes. Immature oocytes of 32 pregnant women were recovered during cesarean section (CS). After retrieval, 92 oocytes were randomly divided into two groups: control (directly disposed to in vitro maturation - IVM) and treated - exposed to BCB 26 μM during 60 min. After staining, the treated group was classified as cytoplasm coloration, BCB positive (blue) or negative (colorless), and then disposed to IVM. Nuclear status was checked after 24 and 48 h of IVM. Nuclear maturation (polar body extrusion), meiosis resumption (absence of germinal vesicle) and degeneration rates were evaluated among the three groups (control, BCB positive and BCB negative) using Generalized Estimating Equations, followed by Bonferroni's correction for multiple comparisons. Nuclear maturation was higher in BCB positive compared to BCB negative, after 24 and 48 h of IVM (p = .004 and p = .032). The control group was equal to BCB positive. There was no difference among groups analyzing meiosis resumption and degeneration rates. The BCB test can be a good marker in pre-selection procedures of developmentally competent human oocytes aspirated during CS.

  7. Haemorrhage during cesarean section for parturient with antiphospholipid syndrome

    Directory of Open Access Journals (Sweden)

    Shruti Shah

    2015-01-01

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

  8. Development and evaluation of cesarean section surgical training using computer-enhanced visual learning.

    Science.gov (United States)

    York, Sloane L; Maizels, Max; Cohen, Elaine; Stoltz, Rachel Stork; Jamil, Adeel; McGaghie, William C; Gossett, Dana R

    2014-11-01

    Skilled performance of cesarean deliveries is essential in obstetrics and gynecology residency. A computer-enhanced visual learning module (CEVL Cesarean) was developed to teach cesarean deliveries. An online module presented cesarean deliveries as a series of components using text, audio, video and animation. First-year residents used CEVL Cesarean and were evaluated intra-operatively by trained raters, then provided feedback about surgical performance. Clinical outcomes were collected for approximately 50 cesarean deliveries for each resident. From 2010 to 2011, 12 first-year residents participated in the study. About 406 unique observed cesarean deliveries were analyzed. Procedures up to each resident's 70th case were analyzed by grouping cases in 10 s (cases 1-10 and 11-20), or deciles. Resident performance significantly improved by decile [χ(2)(6) = 47.56, p < 0.001]. When examining each resident's performance, surgical skill acquisition plateaued by cases 21-30. Procedural performance, independent of resident, also improved significantly by decile [χ(2)(6) = 186.95, p < 0.001], plateauing by decile 4 (cases 31-40). Throughout the observation period, operative time decreased by 3.84 min (p = 0.006). Pre-clinical teaching using computer-based modules for cesarean sections is feasible to develop. Novice surgeons required at least 30 procedures before performing the procedure competently. When residents performed competently, operative time and complications decreased.

  9. Does performing cesarean section after onset of labor has positive effect on neonatal respiratory disorders?

    Science.gov (United States)

    Senturk, Mehmet B; Cakmak, Yusuf; Gündoğdu, Mustafa; Polat, Mesut; Atac, Halit

    2016-01-01

    The aim of this study is to evaluate whether neonatal respiratory disorders relate to the onset of labor or labor pain in patients with history of previous cesarean section. This prospective controlled study comprised 164 patients, grouped according to the presence of labor and related labor pain. All patients in both groups were applied cesarean section at 38 weeks gestational age or beyond due to previous cesarean section. The cord blood pH, Apgar scores and the need for the neonatal intensive care unit were compared. There was a greater need for the neonatal intensive care unit in the control group and the cord blood pH values were higher in the study group (p  0.05). The onset of labor and related labor pain provide a positive contribution to a reduction in neonatal respiratory disorders. Therefore, it can be considered reasonable to perform a cesarean section after the onset of labor or related pain.

  10. [A Case of Emergency Cesarean Section and Craniotomy in a 26 Week Pregnant Woman].

    Science.gov (United States)

    Matsuda, Megumi; Yamazaki, Marie; Osada, Junko; Hirata, Manabu; Amaya, Fumimasa

    2015-02-01

    Intracranial hemorrhage is a rare complication during the pregnancy but carries a poor prognosis. We experienced a case of emergency cesarean section and craniotomy for removal of hematoma due to arteriovenous malformation (AVM) rupture. A 33-year-old woman at 26 weeks of pregnancy suffered a sudden onset of headache and disturbance of consciousness. She was diagnosed with left cerebral hemorrhage due to AVM rupture. Emergency cesarean section was followed by the surgical removal of the hematoma under general anesthesia. Postoperative courses of both mother and baby were satisfactory. The severity of illness of the mother strongly influences her fetus and vise versa. When performing cesarean section before craniotomy, anesthesia should be managed to prevent recurrence of intracranial hemorrhage during the cesarean section and atonic bleeding during the craniotomy. Anesthetist should have adequate knowledge and communicate adequately with obstetrician and pediatrician to achieve better prognosis for the intracranial hemorrhage during pregnancy.

  11. Prevalence of adhesions and associated postoperative complications after cesarean section in Ghana : a prospective cohort study

    NARCIS (Netherlands)

    Nuamah, Mercy A; Browne, Joyce L; Öry, Alexander V; Damale, Nelson K R; Klipstein-Grobusch, Kerstin; Rijken, Marcus J

    2017-01-01

    BACKGROUND: The global increase in Cesarean section rate is associated with short- and long-term complications, including adhesions with potential serious maternal and fetal consequences. This study investigated the prevalence of adhesions and association between adhesions and postoperative

  12. Mixed endometrioid and serous carcinoma developing in abdominal wall endometriosis following Cesarean section

    International Nuclear Information System (INIS)

    Da Ines, David; Montoriol, Pierre Francois; Petitcolin, Virginie; Garcier, Jean-Marc; Bourdel, Nicolas; Canis, Michel; Charpy, Cecile

    2011-01-01

    Abdominal wall endometriosis is unusual and mostly occurs in scars following Cesarean section. Although malignant transformation is rare, it must be recognized in order to benefit from radical resection. We report a very rare case of mixed endometrioid and serous carcinoma developing in a Cesarean section endometriosis scar and the way we managed it using surgery and chemotherapy. 18-FDG PET-CT imaging was performed to correctly stage the disease

  13. Mixed endometrioid and serous carcinoma developing in abdominal wall endometriosis following Cesarean section

    Energy Technology Data Exchange (ETDEWEB)

    Da Ines, David; Montoriol, Pierre Francois; Petitcolin, Virginie; Garcier, Jean-Marc (Dept. of Radiology and Medical Imaging, CHU Clermont-Ferrand, CHU Estaing, Clermont-Ferrand (France)), email: ddaines@chu-clermontferrand.fr; Bourdel, Nicolas; Canis, Michel (Dept. of Obstetrics and Gynecology, CHU Clermont-Ferrand, CHU Estaing, Clermont-Ferrand (France)); Charpy, Cecile (Dept. of Pathology, CHU Clermont-Ferrand, CHU Estaing, Clermont-Ferrand (France))

    2011-06-15

    Abdominal wall endometriosis is unusual and mostly occurs in scars following Cesarean section. Although malignant transformation is rare, it must be recognized in order to benefit from radical resection. We report a very rare case of mixed endometrioid and serous carcinoma developing in a Cesarean section endometriosis scar and the way we managed it using surgery and chemotherapy. 18-FDG PET-CT imaging was performed to correctly stage the disease

  14. [Vesicouterine tiny fistula 8 years after a cesarean section - case report].

    Science.gov (United States)

    Spaček, J; Navrátil, P; Kestřánek, J; Spaček, J; Doležal, J; Broďák, M

    2013-12-01

    To describe a case of uterovesical fistula after cesarean section with symptoms of vulvovaginal discomfort. Case report. Department of Urology, Department of Obstetrics and Gynecology, University Hospital and Medical Faculty in Hradec Kralove, Charles University Prague. Uterovesical fistula is a rare and unusual complication of cesarean section. Uterovesical fistula is tough to diagnose because of unspecific symptoms. A multidisciplinary approach is necessary for its successful diagnosis and treatment.

  15. Cimethidine pre-anesthetic. A prophylactic method against Mendelson's syndrome in cesarean section

    DEFF Research Database (Denmark)

    Qvist, N; Storm, K

    1983-01-01

    Twenty patients undergoing cesarean section received cimethidine 400 mg intramuscularly as pre-anesthetic approximately 70 minutes prior to gastric aspiration. The average pH was 5.05, as against 2.97 in the control group (p less than 0.01). No significant reduction in the aspirated volumes...... in the infants. Hence, cimethidine is a safe and useful pre-anesthetic for patients undergoing cesarean section, irrespective of indication and, consequently, much to be preferred to oral antacids....

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

    DEFF Research Database (Denmark)

    Schroeder, T; Kristensen, J K

    1983-01-01

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

  17. [Epidemiological profile of maternal complications related to cesarean section at the Al Farabi Hospital in Oujda].

    Science.gov (United States)

    Benkirane, Saad; Saadi, Hanane; Mimouni, Ahmed

    2017-01-01

    In Morocco cesarean section rate has increased from 2% in 1992 to 16% in 2011. This was associated with increased per- and postoperative mortality and morbidity, which was 19% in our case series. This study is the first of its kind to be conducted in the eastern region of Morocco and aims to analyze the comprehensive epidemiologic profile of maternal complications related to cesarean section on the basis of 2417 cases observed in the Maternity Department at the El Farabi Hospital, Oujda. We conducted an observational, descriptive, retrospective study of a series of 2416 patients undergoing cesarean section in the Maternity Department at the El Farabi Hospital, Oujda, over the period 1 January 2011-31 December 2013. Out of 24464 deliveries, 2416 were cesarean sections, reflecting a rate of 9.87%. The frequency of complications related to cesarean section was 19.45%. Postoperative complications accounted for 63.6% of the complications dominated by infection. Haemorrhagic complications accounted for 25.53% of all complications. 4 cases of maternal deaths were recorded. If the increased rate of cesarean sections has contributed to improve maternal-fetal prognosis, the surgical act itself is not complication-free, which leads us to review its indications for improved patient management.

  18. Can oxytocin augmentation modify the risk of epidural analgesia by maternal age in cesarean sections?

    Science.gov (United States)

    Rossen, Janne; Klungsøyr, Kari; Albrechtsen, Susanne; Løkkegård, Ellen; Rasmussen, Steen; Bergholt, Thomas; Skjeldestad, Finn E

    2018-03-07

    Maternal age is an established risk factor for cesarean section; epidural analgesia and oxytocin augmentation may modify this association. We investigated the effects and interactions of oxytocin augmentation, epidural analgesia and maternal age on the risk of cesarean section. In all, 416 386 nulliparous women with spontaneous onset of labor, ≥37 weeks of gestation and singleton infants with a cephalic presentation during 2000-2011 from Norway and Denmark were included [Ten-group classification system (Robson) group 1]. In this case-control study the main exposure was maternal age; epidural analgesia, oxytocin augmentation, birthweight and time period were explanatory variables. Chi-square test and logistic regression were used to estimate associations and interactions. The cesarean section rate increased consistently with advancing maternal age, both overall and in strata of epidural analgesia and oxytocin augmentation. We observed strong interactions between maternal age, oxytocin augmentation and epidural analgesia for the risk of cesarean section. Women with epidural analgesia generally had a reduced adjusted odds ratio when oxytocin was used compared with when it was not used. In Norway, this applied to all maternal age groups but in Denmark only for women ≥30 years. Among women without epidural, oxytocin augmentation was associated with an increased odds ratio for cesarean section in Denmark, whereas no difference was observed in Norway. Oxytocin augmentation in nulliparous women with epidural analgesia is associated with a reduced risk of cesarean section in labor with spontaneous onset. © 2018 Nordic Federation of Societies of Obstetrics and Gynecology.

  19. Postdischarge surveillance following cesarean section: the incidence of surgical site infection and associated factors.

    Science.gov (United States)

    Cardoso Del Monte, Meire Celeste; Pinto Neto, Aarão Mendes

    2010-08-01

    The rate of surgical site infections (SSI) and their associated risk factors was identified by performing postdischarge surveillance following cesarean section at a public university teaching hospital in Brazil. The study was conducted at the Center for Women's Integrated Health Care in Brazil between May 2008 and March 2009. Women were contacted by telephone 15 and 30 days after cesarean section. During hospitalization, a form was completed on factors associated with post-cesarean SSI. The chi(2) test and Fisher exact test were used to analyze categorical variables and the Mann-Whitney test for numerical variables. Relative risks (RR) and their respective 95% confidence intervals (95% CI) were calculated for factors associated with SSI. P values cesarean section SSI. A 15-day postdischarge follow-up was shown to be sufficient. Hypertension was a factor associated with SSI. Copyright 2010 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  20. Robotic-assisted Laparoscopic Repair of a Cesarean Section Scar Defect.

    Science.gov (United States)

    Mahmoud, Mohamad S; Nezhat, Farr R

    2015-01-01

    To describe our technique for the repair of a cesarean section uterine scar defect after removal of an ectopic pregnancy from the scar in a patient desiring future pregnancies. Step-by-step explanation of the procedure using video (Canadian Task Force classification III). Uterine scar dehiscence/defect is a known complications of multiple cesarean deliveries that can result in abnormal bleeding, infertility, and cesarean scar ectopic pregnancy. With the increasing number of cesarean sections performed in the United States, the prevalence of this complication is rising. Nonetheless, there currently are no standardized surgical treatment guidelines available to manage this pathology through a minimally invasive approach. In this video, we describe our technique for the surgical management of a symptomatic cesarean section scar defect. We performed a robotic-assisted laparoscopic repair of this defect in a 40-year-old G4P3013 with a recent cesarean section scar ectopic pregnancy managed by endometrial curettage, with subsequent persistent abnormal vaginal bleeding. A repeat ultrasound revealed a low uterine segment defect consistent with dehiscence. She was referred to us because she desired a conservative treatment given her desire for future pregnancies. The defect was localized by hysteroscopy and laparoscopy after developing the bladder flap. The scar tissue around the defect was resected, and the freshened edges of the defect were closed using delayed absorbable suture. Chromopertubation confirmed the watertightness of the repair. Postoperatively, the patient had regular normal periods, and her hysterosalpingogram didn't show any uterine defect. Robotic-assisted laparoscopic repair of cesarean section scar defect is a feasible and safe procedure when done with respect to anatomy and following sound surgical technique. With the increasing number of cesarean sections, gynecologists will be dealing with this pathology more frequently, and need to become more

  1. Re-laparotomy after cesarean section: operative complications in surgical delivery.

    Science.gov (United States)

    Gedikbasi, Ali; Akyol, Alpaslan; Asar, Emel; Bingol, Banu; Uncu, Remzi; Sargin, Akif; Ceylan, Yavuz

    2008-11-01

    To determine the risk factors causing re-laparotomy and the indications, management and outcomes of re-laparotomy after a cesarean section. We had, during the study period of January 2002 to January 2007, 28,799 cesarean sections and 35 cases with re-laparotomy. We studied the patients' age, parity, indications for cesarean section and indications for re-laparotomy, time interval after cesarean section to reopening of the abdomen, type of surgery, need for blood transfusion and span of hospital stay. The incidence of re-laparotomy was 0.12%. Cases with placental abruption and previous cesarean > or =3 had a higher risk for re-laparotomy. Procedures that were performed at re-laparotomy were drainage and resuturing of hematomas (n = 8), resuturing of uterus and securing hemostasis with stitches (n = 10), bladder repair (n = 1), herniation repair (n = 1), total abdominal hysterectomy (n = 2), subtotal abdominal hysterectomy (n = 5), and draining and resuturing of broad ligament, parametrium, abdominal wound, and cutaneous and subcutaneous tissue due to infection and abscess formation (n = 8). Two cases required admission into the intensive care unit. We had one case with maternal mortality. Majority of the complications were revealed at an early period and these were hemorrhagic cases mostly. Although the rate of re-laparotomy after cesarean section is low, several actions must be undertaken to decrease the need for re-laparotomy. In particular, cases with placental abruption and previous cesarean > or =3 are with higher risk for re-laparotomy and have a 15-fold risk for re-laparotomy after cesarean section.

  2. Characterizing the need for re-laparotomy during puerperium after cesarean section.

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    Ashwal, Eran; Yogev, Yariv; Melamed, Nir; Khadega, Rian; Ben-Haroush, Avi; Wiznitzer, Arnon; Peled, Yoav

    2014-07-01

    As inconsistency exists concerning the rate and risk factors for re-laparotomy after cesarean section (CS), we aimed to determine the incidence, risk factors and indications for re-laparotomy after CS. This is a retrospective study. Women underwent re-laparotomy following CS were compared to a control group in a 1:3 ratio. Demographic, obstetrical and surgical data were analyzed. CS complications were defined as intra-operative abnormal hemorrhage, summoning surgical personnel, inverted T incision, uterine and/or hypogastric arteries ligation or cesarean hysterectomy. Overall, 35,779 women delivered during the study, of them 7,926 by CS (22.1 %) and 62 patients (0.7 %) underwent re-laparotomy. Re-laparotomies occur during the first 24 h, first week and beyond it, following CS in 64.5, 22.6 and 12.9 %, respectively. Previous abdominal/pelvic surgery (14.5 vs. 8.1 %, p complications (26.8 vs. 0.5 %, p complication (40.7 vs. 0.5 %, p < 0.001) and adhesions (65.5 vs. 33.3 %, p < 0.001) were significantly increased in the study group. Indications for re-laparotomy varied according to the interval elapsed to the re-laparotomy with post-partum hemorrhage (27.4 %) being the leading indication in the early period. Risk factors for re-laparotomy following CS can be recognized and are mainly associated with previous abdominal and/or pelvic surgeries and intra-operative adhesions.

  3. Vaginal delivery versus cesarean section for term breech delivery

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    Babović Ivana

    2010-01-01

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

  4. Prevalence and Causes of Cesarean Section in Iran: Systematic Review and Meta-Analysis

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    AZAMI-AGHDASH, Saber; GHOJAZADEH, Morteza; DEHDILANI, Nima; MOHAMMADI, Marzieh; ASL AMIN ABAD, Ramin

    2014-01-01

    Abstract Unfortunately, the prevalence of cesarean section has increased in recent years. Whereas awareness of the prevalence and causes is inevitable for planning and effective interventions, so aim of this study has designed and conducted for reviewing of systematic Prevalence and caesarean causes in Iran. In this meta-analysis, the required information have been collected using several keywords which are Cesarean section rate, Cesarean section prevalence, delivery, childhood, childbirth, relative causes, relative frequency, Iran and their Persian equivalents have been collected from databases such as CINAHL, Science Direct, PubMed, Magiran, SID, Iranmedex. Finally, we found 706 related articles and selected 34 articles among them for studying of cesarean Prevalence. We used CMA software with random model for Meta-Analysis. The prevalence of Cesarean was estimated48%. Using content analysis, Factors influencing the incidence of cesarean section were divided to 3 categories including social and demographic factors, obstetric-medical causes and non-obstetric-medical causes. Maternal education and grand multiparity in the field of demographic and social factors, previous cesarean in the field of obstetric-medical causes and fear of normal-vaginal delivery (NVD) and doctor’s suggestion in the field of non-obstetric-medical causes were major causes of Cesarean. According to the high prevalence of caesarean section and it upward development, it seems to be essential designing and implementing of programs and interventions effectiveness including providing of Possibility of painless childbirth and education and psychological interventions, increasing of quality of natural delivery services, proper culture and prohibiting of doctors from Personal opinions and profit. PMID:26060756

  5. Efficacy and safety of venous thromboembolism prophylaxis with fondaparinux in women at risk after cesarean section.

    Science.gov (United States)

    Kawaguchi, Ryuji; Haruta, Shoji; Kobayashi, Hiroshi

    2017-11-01

    Cesarean section is associated with an increased risk for venous thromboembolism (VTE). The safety and efficacy of primary prophylaxis of fondaparinux, a synthetic sulfated pentasaccharide heparin analog, in women at risk after cesarean section is uncertain. This was a retrospective study of 295 cases of pregnant women presenting to a tertiary referral center of Nara, Japan, to evaluate the usefulness of thromboprophylaxis with fondaparinux after cesarean delivery between 2011 and 2012. Patients were initially received unfractionated heparin (once 5,000 IU subcutaneously, twice a day), starting 6 hours after cesarean section for 24 hours, and then treated with fondaparinux (once 2.5 mg daily, subcutaneously) for 5 days. The primary efficacy end-point was an improvement in the incidence of symptomatic VTE or fatal post-cesarean pulmonary thromboembolism. The primary safety end-point was major bleeding during treatment. There were neither any episodes of symptomatic VTE cases nor maternal deaths. A total of 10 patients had a bleeding event. Major bleeding complication was observed in 2 (0.68%) of 295 patients receiving fondaparinux. Non-major bleeding into critical sites was observed in 8 patients, often at surgical sites, and recovery was not delayed. This study demonstrates the safety and efficacy of fondaparinux in women at high risk of VTE after cesarean section. Large phase trials comparing clinical outcomes with fondaparinux across a wide spectrum of patients are needed to confirm these observations.

  6. Factors contributing to the decision to perform a cesarean section in Labrador retrievers.

    Science.gov (United States)

    Dolf, Gaudenz; Gaillard, Claude; Russenberger, Jane; Moseley, Lou; Schelling, Claude

    2018-02-27

    In the past 10 years, the frequency of unplanned cesarean sections in the Labrador Retriever breeding colony at Guiding Eyes for the Blind stayed around 10% (range 5% to 28%). To reduce the number of cesarean sections, factors influencing the occurrence of a cesarean section need to be known. The goal of this study was to identify factors that contribute to the decision to perform a cesarean section. Of the 688 Labrador Retriever litters whelped between 2003 and 2016, 667 litters had sufficient data and remained in the analysis. The target trait was ordinal with the three levels "normal whelping", "assisted whelping" and "cesarean section". A general ordinal logistic regression approach was used to analyze the data. Model selection with possible predictors resulted in a final model including weight of the dam, the weight of the heaviest puppy of a litter, the number of fetuses malpositioned and the quality of uterine contractions. Weight and size of a litter, parity, maternal inbreeding coefficient, whelping season, dam and sire were dropped from the model because they were not significant. The risk of a cesarean section was influenced by the combination of the weight of the dam and the weight of the heaviest puppy in the litter, as well as by the number of malpositioned fetuses and the quality of the contractions. Larger puppies increased the risk of cesarean section especially when the dam had a lighter weight. For dams weighing 23.6 kg and 32.8 kg the predicted probability of a cesarean section was low, with 0.06 and 0.02, respectively, when the heaviest puppy in a litter was light (0.42 kg), contractions were normal and no fetus was malpositioned. However, the probability of a cesarean section was much higher, ranging from 0.24 to 0.08, when the heaviest puppy in a litter was heavy (0.66 kg). Means to reduce the cesarean section frequency in this Labrador Retriever breeding colony should include genetic selection for ideal puppy weight. In addition, dams

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

    Science.gov (United States)

    Kinay, Tugba; Basarir, Zehra O; Tuncer, Serap F; Akpinar, Funda; Kayikcioglu, Fulya; Koc, Sevgi; Karakaya, Jale

    2016-08-01

    To determine whether a history of cesarean section was a risk factor for abnormal uterine bleeding in patients with uterine leiomyomas, and to identify other risk factors for this symptom. We analyzed retrospectively, the medical records of patients who underwent hysterectomies due to the presence of uterine leiomyomas during a 6-year period (2009 and 2014) at Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey. Uterine leiomyoma was diagnosed based on histopathological examination of hysterectomy specimens. Demographic characteristics, and laboratory and histopathological findings were compared between patients with uterine leiomyoma with and without abnormal uterine bleeding. In total, 501 (57.9%) patients had abnormal uterine bleeding and 364 (42.1%) patients had other symptoms. A history of cesarean section was more common in patients with abnormal uterine bleeding than in those with other symptoms (17.6% versus 9.3%, p=0.001; odds ratio [OR]: 2.1; 95% confidence interval [CI]: 1.4-3.3). The presence of a submucosal leiomyoma (OR: 2.1; 95% CI: 1.5-3.1) and coexistent adenomyosis (OR: 1.6; 95% CI: 1.1-2.4) were also associated with abnormal uterine bleeding. A history of cesarean section was an independent risk factor for abnormal uterine bleeding in patients with uterine leiomyomas; submucosal leiomyoma and coexisting adenomyosis were also independent risk factors.

  8. Effect of pre-emptive magnesium sulfate infusion on the post-operative pain relief after elective cesarean section

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    Marzieh Rezae

    2014-01-01

    Full Text Available Background: The aim of this study was to evaluate the analgesic efficacy of pre-operative single dose of intravenous (I.V. magnesium sulfate infusion in patients undergoing elective Cesarean section. Materials and Methods: Seventy pregnant women who underwent elective Cesarean section were randomly divided into two groups. Before induction of anesthesia, the magnesium group (Group A received magnesium sulfate 50 mg/kg I.V. in bolus dose. The control group (Group B received the same volume of isotonic saline. The pain scores at rest and also upon movement were evaluated up to 24 h post-operatively and analgesic requirement was recorded during the first 24 h after operation. Results: Cumulative analgesic consumption (24 h after operation was 11.2 ± 6.3 mg in group A vs. 13.9 ± 3.9 mg in group B. Post-operative pain scores (24 h after operation was 1.8 ± 2.1 in group A vs. 2.9 ± 1.2 in group B and shivering incidents (8.57 in group A vs. 14.28 in group B were significantly lower in Group A (P < 0.05. Mean arterial pressure just after intubation and during the immediate post-operative period was significantly lower in Group A (P < 0.05. Conclusion: Pre-operative intravenous magnesium sulfate infusion decrease post-operation pain and requirement of analgesia in Cesarean section.

  9. The Interrelationship Between Repeat Cesarean Section, Smoking Status, and Breastfeeding Duration.

    Science.gov (United States)

    Wallenborn, Jordyn T; Masho, Saba W

    2016-11-01

    The rate of breastfeeding duration is staggeringly low with only one-quarter of infants in the United States being exclusively breastfed at 6 months. Maternal smoking and mode of delivery have been identified as independent risk factors for shorter breastfeeding duration. This study aims to evaluate the effect of repeat cesarean delivery on breastfeeding duration, taking into account smoking status. Data from the U.S. population-based Pregnancy Risk Assessment Monitoring System survey, 2004-2011, were analyzed. Women who delivered a live singleton baby, had a previous birth through cesarean delivery, and provided mode of delivery and breastfeeding information were included in the analysis. Multinomial logistic regression models provided crude and adjusted odds ratios (AORs) and 95% confidence intervals (CIs). All models were stratified by smoking status. Among smokers, women who had repeat cesarean section had a 2-fold higher odds of never breastfeeding (AOR = 2.43, 95% CI = 1.38-4.29) and a 4-fold higher odds of breastfeeding 8 weeks or less (AOR = 4.11, 95% CI = 2.08-8.11) compared with women who gave birth vaginally after cesarean section. Among nonsmokers, the odds of never breastfeeding and breastfeeding 8 weeks or less were 2.4 times (AOR = 2.36, 95% CI = 1.84-3.03) and 1.4 times (AOR = 1.44, 95% CI = 1.15-1.80) higher in women who had repeat cesarean section compared with women who had vaginal birth after cesarean section, respectively. Among women who smoke during pregnancy, the results suggest that repeat cesarean delivery negatively affects breastfeeding duration. Interventions are needed for mothers who smoke during pregnancy and undergo repeat cesarean delivery.

  10. Re-laparotomy After Cesarean Section: Risk, Indications and Management Options

    OpenAIRE

    Raagab, Ahmed E; Mesbah, Yasir H.; Brakat, Rafik I; Zayed, Abdelhadi A.; Alsaammani, Mohamed Alkhatim

    2014-01-01

    ABSTRACT Aim: To identify risks, indications and outcomes for relaparotomy after cesarean delivery. Methods: A prospective case-controlled study conducted at Mansoura University Hospital, Egypt from 2009 to 2012. Each case was matched randomly to 2 cases that had delivered by cesarean section during the same period and did not undergo repeated surgical intervention. Information's on indications were obtained to gather information's on risks factors. Results: relaparotomy complicated 1.04 %(n=...

  11. Re-laparotomy after cesarean section: risk, indications and management options.

    Science.gov (United States)

    Raagab, Ahmed E; Mesbah, Yasir H; Brakat, Rafik I; Zayed, Abdelhadi A; Alsaammani, Mohamed Alkhatim

    2014-01-01

    To identify risks, indications and outcomes for relaparotomy after cesarean delivery. A prospective case-controlled study conducted at Mansoura University Hospital, Egypt from 2009 to 2012. Each case was matched randomly to 2 cases that had delivered by cesarean section during the same period and did not undergo repeated surgical intervention. Information's on indications were obtained to gather information's on risks factors. relaparotomy complicated 1.04% (n = 26) of the total number of the cesarean section (CS) (n = 2500). The principal indications for relaparotomy were internal bleeding (Intra-abdominal bleeding in 41.7% (n = 10); rectus sheath hematoma in 29.2% (n = 7) and uncontrolled postpartum hemorrhage (PPH) in 29.2% (n = 7) of cases, followed by infections in 7.7% (n = 2) of cases. Resulting in 11.5% (n = 3) maternal death. Predictors for relaparotomy after cesarean delivery from univariate logistic model, placenta previa (OR = 6.898, 95% CI = 1.867- 25.4, P = .004), fetal weight greater than 4 kg (OR = 6.409, 95% CI = 1.444-28.44, .015). Previous cesarean section and parity were not a risk for re-laparotomy. In this study, the incidence of relaparotomy after cesarean delivery was very high (1.04%). Associated with high maternal mortality (11.5%). The main predictors were placenta previa and fetal macrosomia.

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

    Science.gov (United States)

    Benevides, Márcio Luiz; Brandão, Verônica Cristina Moraes; Lovera, Jacqueline Ivonne Arenas

    2016-01-01

    The increased prevalence of obesity in the general population extends to women of reproductive age. The aim of this study is to report the perioperative management of a morbidly obese pregnant woman, body mass index >50kg/m(2), who underwent cesarean section under general anesthesia. Pregnant woman in labor, 35 years of age, body mass index 59.8kg/m(2). Cesarean section was indicated due to the presumed fetal macrosomia. The patient refused spinal anesthesia. She was placed in the ramp position with cushions from back to head to facilitate tracheal intubation. Another cushion was placed on top of the right gluteus to create an angle of approximately 15° to the operating table. Immediately before induction of anesthesia, asepsis was carried out and sterile surgical fields were placed. Anesthesia was induced in rapid sequence, with Sellick maneuver and administration of remifentanil, propofol, and succinilcolina. Intubation was performed using a gum elastic bougie, and anesthesia was maintained with sevoflurane and remifentanil. The interval between skin incision and fetal extraction was 21min, with the use of a Simpson's forceps scoop to assist in the extraction. The patient gave birth to a newborn weighing 4850g, with Apgar scores of 2 in the 1st minute (received positive pressure ventilation by mask for about 2min) and 8 in the 5th minute. The patient was extubated uneventfully. Multimodal analgesia and prophylaxis of nausea and vomiting was performed. Mother and newborn were discharged on the 4th postoperative day. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

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

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    Márcio Luiz Benevides

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

  14. Circulating maternal cortisol levels during vaginal delivery and elective cesarean section.

    Science.gov (United States)

    Stjernholm, Ylva Vladic; Nyberg, Annie; Cardell, Monica; Höybye, Charlotte

    2016-08-01

    Maternal S-cortisol levels increase throughout pregnancy and peak in the third trimester. Even higher levels are seen during the physical stress of delivery. Since analgesia for women in labor has improved, it is possible that maternal stress during labor is reduced. The aim of this study was to compare maternal S-cortisol during vaginal delivery and elective cesarean section. Twenty healthy women with spontaneous vaginal delivery and healthy women (n = 20) undergoing elective cesarean section were included in the study. S-cortisol was measured during three stages of spontaneous vaginal delivery (tvd1, tvd2 and tvd3), as well as before and after elective cesarean section (tcs1 and tcs2). In the vaginal delivery group, mean S-cortisol at tvd1 was 1325 ± 521 nmol/L, at tvd2 1559 ± 591 nmol/L and at tvd3 1368 ± 479 nmol/L. In the cesarean section group, mean S-cortisol at tcs1 was 906 ± 243 nmol/L and at tcs2 831 ± 257 nmol/L. S-cortisol was higher in the vaginal delivery group at the onset of labor as compared to the cesarean section preoperative group (p = 0.006). There were also significant differences between S-cortisol levels postpartum as compared to postoperatively (p cesarean section, indicating higher stress levels. A reduction in the hydrocortisone dose at childbirth in women with adrenal insufficiency should be considered, particularly in women undergoing an elective cesarean section.

  15. Predictive model for risk of cesarean section in pregnant women after induction of labor.

    Science.gov (United States)

    Hernández-Martínez, Antonio; Pascual-Pedreño, Ana I; Baño-Garnés, Ana B; Melero-Jiménez, María R; Tenías-Burillo, José M; Molina-Alarcón, Milagros

    2016-03-01

    To develop a predictive model for risk of cesarean section in pregnant women after induction of labor. A retrospective cohort study was conducted of 861 induced labors during 2009, 2010, and 2011 at Hospital "La Mancha-Centro" in Alcázar de San Juan, Spain. Multivariate analysis was used with binary logistic regression and areas under the ROC curves to determine predictive ability. Two predictive models were created: model A predicts the outcome at the time the woman is admitted to the hospital (before the decision to of the method of induction); and model B predicts the outcome at the time the woman is definitely admitted to the labor room. The predictive factors in the final model were: maternal height, body mass index, nulliparity, Bishop score, gestational age, macrosomia, gender of fetus, and the gynecologist's overall cesarean section rate. The predictive ability of model A was 0.77 [95% confidence interval (CI) 0.73-0.80] and model B was 0.79 (95% CI 0.76-0.83). The predictive ability for pregnant women with previous cesarean section with model A was 0.79 (95% CI 0.64-0.94) and with model B was 0.80 (95% CI 0.64-0.96). For a probability of estimated cesarean section ≥80%, the models A and B presented a positive likelihood ratio (+LR) for cesarean section of 22 and 20, respectively. Also, for a likelihood of estimated cesarean section ≤10%, the models A and B presented a +LR for vaginal delivery of 13 and 6, respectively. These predictive models have a good discriminative ability, both overall and for all subgroups studied. This tool can be useful in clinical practice, especially for pregnant women with previous cesarean section and diabetes.

  16. Maternal and neonatal copeptin levels at cesarean section and vaginal delivery.

    Science.gov (United States)

    Foda, Ashraf A; Abdel Aal, Ibrahim A

    2012-12-01

    The objective of the study was to measure the copeptin levels in maternal serum and umbilical cord serum at cesarean section and vaginal delivery in normotensive pregnancy and pre-eclamptic women. This was a prospective study at Mansoura University Hospital, Egypt. Ninety cases were included. They were divided into six groups: (1) normal pregnancy near term, as a control group, (2) primiparas who had vaginal delivery, (3) primiparas who had vaginal delivery and mild preeclampsia, (4) elective repeat cesarean section, (5) intrapartum cesarean section for indications other than fetal distress, and (6) intrapartum cesarean section for fetal distress. Serum copeptin concentrations were quantified with an enzyme-linked immunosorbent assay (ELISA). Mean, standard deviation, and paired t-test were used to test for significant change in quantitative data. The vaginal delivery groups had higher levels of maternal serum copeptin than the elective cesarean section group (P<0.01). Higher maternal serum copeptin levels were found in cases with pre-eclampsia as compared with the normotensive cases. The maternal copeptin levels during intrapartum cesarean section were higher than that during elective repeat cesarean section. There was a significant correlation between maternal copeptin levels and the duration of the first stage. In the presence of fetal distress, umbilical cord serum copeptin levels were significantly higher than other groups. Vaginal delivery can be very painful and stressful, and is accompanied by a marked increase of maternal serum copeptin. Increased maternal levels of serum copeptin were found in cases with pre-eclampsia as compared with the normotensive cases, and it may be helpful in assessing the disease. Intrauterine fetal distress is a strong stimulus to the release of copeptin into the fetal circulation. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

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

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    Venkata Sujatha Vellanki

    2010-12-01

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

  18. Predictions for the decision-to-delivery interval for emergency cesarean sections in Norway.

    Science.gov (United States)

    Kolås, Toril; Hofoss, Dag; Oian, Pål

    2006-01-01

    To explain the variation in decision-to-delivery intervals in emergency cesarean sections in Norway. A seven-month prospective registration of all emergency cesareans provided by 24 maternity units. The clinician in charge filled in a predesigned form for each delivery that obtained detailed information about obstetric history, the pregnancy, indication, the date and time of delivery, decision-to-delivery interval, seniority of the surgeon, and neonatal outcome until hospital discharge. To take account of the clustered nature of our observations, data were analyzed by multilevel regression. 1,511 singleton emergency cesarean sections with known decision-to-delivery interval were included. The average decision-to-delivery interval for all emergency cesarean sections was 52.4 min, for acute cesarean sections 58.7 min, and for urgent emergency operations 11.8 min. Most of the decision-to-delivery interval variation was at patient level, not between departments. Several significant decision-to-delivery interval predictors were identified: 1. abruptio placentae (-54 min), umbilical cord prolapse (-37 min), and fetal stress (-35 min); 2. general anesthesia (versus regional) (-15 min), 3. cesarean sections performed during night-time (-10 min), 4. seniority of the surgeon (-6 min), and 5. cervical opening (for each cm: -6 min). The variance in the decision-to-delivery interval was mainly explained by the different nature of the cesarean sections. The most important predictors, which all acted to reduce decision-to-delivery interval, were the three indications abruptio placentae, cord prolapse, and fetal stress. Sections performed during night-time had significantly reduced decision-to-delivery interval. The size of the maternal units as measured by number of deliveries per year was not a significant predictor.

  19. Maternal and fetal mortality and complications associated with cesarean section deliveries in teaching hospitals in Asia.

    Science.gov (United States)

    Chongsuvivatwong, Virasakdi; Bachtiar, Hafni; Chowdhury, Mahbub Elahi; Fernando, Sunil; Suwanrath, Chitkasaem; Kor-Anantakul, Ounjai; Tuan, Le Anh; Lim, Apiradee; Lumbiganon, Pisake; Manandhar, Bekha; Muchtar, Masrul; Nahar, Lutfan; Hieu, Nguyen Trong; Fang, Pan Xiao; Prasertcharoensuk, Witoon; Radnaabarzar, Erdenetungalag; Sibuea, Daulat; Than, Kyu Kyu; Tharnpaisan, Piangjit; Thach, Tran Son; Rowe, Patrick

    2010-02-01

    To compare the mortality, morbidity of emergency and elective cesarean section with vaginal delivery among Asian teaching hospitals. Hospital based prospective study at 12 centers of 9 countries. 12 591 vaginal deliveries, 3062 elective and 4328 emergency cesarean section were followed up to 5 days postpartum. Maternal deaths (95% CI) per 1000 births among vaginal deliveries being 0.47 (0.17, 1.03) was not significantly different from 0.31 (0.01, 1.73) of elective cesarean section and both rates were significantly lower than 2.87 (1.53, 4.91) per 1000 births of emergency section. The vaginal delivery group had significantly lower incidences of all major complication except significantly higher chance of secondary operations and non-significantly different risk for endometritis. Corresponding neonatal mortality per 1000 deliveries among the three groups were 7 (5.6, 8.6), 2.2 (0.9, 4.6) and 12.4 (9.3, 16.2) (P cesarean section. Maternal complications were increased by cesarean delivery but elective section may reduce neonatal complication.

  20. Vaginal birth after cesarean section: 10 years of experience in a tertiary medical center in Taiwan.

    Science.gov (United States)

    Li, Wai-Hou; Yang, Ming-Jie; Wang, Peng-Hui; Juang, Chi-Mou; Chang, Yi-Wen; Wang, Hsing-I; Chen, Chih-Yao; Yen, Ming-Shyen

    2016-06-01

    Because of the increased risk of uterine rupture and other morbidities, instances of trial of labor after cesarean (TOLAC) have decreased in number each year. Nevertheless, under careful assessment and advanced medical care, TOLAC is still a safe option for delivery. The objective of this study is to find the factors that impact the success rate for TOLAC and to compare the results with Taiwan national registry data. A longitudinal cohort study that includes a total of 254 cases of women receiving TOLAC in a tertiary medical center over a period of 10 years. A total of 254 participants who underwent TOLAC, which accounts for 1.67% of total labor instances (254/15,166), were enrolled for analysis. The success rate of TOLAC was found to be 80.70% (205/254), including 146 (57.5%) normal deliveries, 45 (17.7%) vacuum-assisted deliveries, and 14 (5.5%) forceps-assisted deliveries. The conversion rate to cesarean section was 19.3%. There were no uterine rupture cases in our study, and there were only two suspected cases, which turned out to have no actual rupture. When analyzing the factors affecting the results of TOLAC, we found that a successfully spontaneously delivered baby had a lower birth weight than the failed TOLAC cases that were converted to cesarean delivery (mean, 2989 g vs. 3379 g; p cesarean section, the most common reason was dysfunctional labor (79.6%), followed by fetal distress (14.3%). Under intensive care and observation, TOLAC section may still be a feasible choice. Nevertheless, the body weight of the baby has been shown to be a factor that can influence the success rate. Copyright © 2016. Published by Elsevier B.V.

  1. "Informed" Consent: An Audit of Informed Consent of Cesarean Section Evaluating Patient Education and Awareness.

    Science.gov (United States)

    Kirane, Akhilesh G; Gaikwad, Nandkishor B; Bhingare, Prashant E; Mule, Vidya D

    2015-12-01

    Better diagnosis and early referral due to increased health care coverage have increased the cesarean deliveries at tertiary-care hospitals of India. Improvements in the health care system raise many concerns and need of cross-checking system in place to counter the problems pertaining to patient education and participation of patient. While most of the cesarean sections are done in good faith for the patient, it does not escape the purview of consumer awareness and protection. This cross-sectional study was undertaken at a tertiary level government institution to understand the level of awareness of 220 patients regarding the various aspects of cesarean delivery which are essential for women to know before giving an informed consent. 71 % of the women had knowledge about the indication and need to do cesarean delivery. Of these, only one-third (25 % of total women) were properly explained about procedure and complications. Other demographic and social characteristics were also evaluated. While the health care schemes have had their improved results, the onus lies upon the caregivers to improve and maintain the quality of health care in these tertiary-care government hospitals in proportion to the increase in patient load. The results of this study highlight the need for proper counseling of patients regarding complications of cesarean section. The fact that only 25 % of total cases were explained proper procedure and complication as opposed to 71 % of patients having proper knowledge about the indication of cesarean section points out the lack of information in seemingly "informed" consent. To bring about awareness about the risks and complications of cesarean section, there is a need that patients be counseled during the antenatal visits, specifically when patients visit near term for antenatal check up.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-08-15

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

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

    International Nuclear Information System (INIS)

    Ustunsoz, Bahri; Ugurel, Sahin; Duru, Namik Kemal; Ozgok, Yasar; Ustunsoz, Ayfer

    2008-01-01

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

  4. Monitoring of plethysmography variability index and total hemoglobin levels during cesarean sections with antepartum hemorrhage for early detection of bleeding

    Directory of Open Access Journals (Sweden)

    Ahmed Elsakka

    2017-01-01

    Conclusion: Plethysmography variability index and non invasive hemoglobin monitoring as well can be used for optimization of intravascular volume status during cesarean sections in parturients with antepartum hemorrhage.

  5. Underreporting of complete uterine rupture and uterine dehiscence in women with previous cesarean section.

    Science.gov (United States)

    Fogelberg, Maria; Baranov, Anton; Herbst, Andreas; Vikhareva, Olga

    2017-09-01

    To determine the true incidence of complete uterine rupture and uterine dehiscence among women delivered by cesarean section after a previous cesarean section. Medical records of all women who delivered at University Hospital in Malmö, Sweden, during 2005-2009 (n = 21 420) were retrieved from the electronic patient record system (EPRS). After adjustment for inaccuracies, 716 women who had undergone repeat cesarean section were identified and their operation reports were reviewed. Descriptions of complete uterine rupture or uterine dehiscence in operation reports were compared with diagnoses registered in EPRS with International Classification of Diseases codes version 10 (ICD-10). Sensitivity and specificity of complete uterine rupture registration were calculated. There were 13 women with a registered diagnosis of uterine rupture. After reviewing medical records of women with repeat cesarean section, seven additional cases of complete uterine rupture, 33 cases of uterine dehiscence and 39 cases of extremely thin myometrium were identified. The incidence of complete uterine rupture and uterine dehiscence for women who delivered by repeat cesarean section was 2.8% and 10.1%, respectively. Diagnosis of complete uterine rupture was underreported in the EPRS by 35% and diagnosis of uterine dehiscence was missing in 100% of cases.

  6. Cosmetic outcomes of cesarean section scar; subcuticular suture versus intradermal buried suture.

    Science.gov (United States)

    Yang, Juseok; Kim, Ki Hyung; Song, Yong Jung; Kim, Seung-Chul; Sung, Nayoung; Kim, Haneul; Lee, Dong Hyung

    2018-01-01

    The objective of the study was to compare cosmetic outcomes and overall satisfaction rate of cesarean section scar between conventional subcuticular suture and intradermal buried vertical mattress. Patients were enrolled to the study by chart review. A scar assessment was obtained retrospectively through a telephone survey. The patient component of the patient and observer scar assessment scale (POSAS) was utilized along with the overall satisfaction of the patient regarding their cesarean section scar and their willingness to choose the same skin closure technique when anticipating their next cesarean section. A total of 303 cases of cesarean section was recruited, 102 finished telephone surveys were calculated for the analyses. Subcuticular suture was regarded as control group (n=52) and intradermal buried suture as test group (n=50). The PSAS score of the test group (mean, 21.8) was lower than that of the control group (mean, 28), with a statistical significance ( P =0.02). Overall satisfaction rate did not differ between the two groups. Two parameters of the PSAS score and the level of overall satisfaction showed significant correlation (Pearson's r , -0.63; P cesarean sections over subcuticular stitch.

  7. Efficacy of ondansetron for spinal anesthesia during cesarean section: a meta-analysis of randomized trials.

    Science.gov (United States)

    Zhou, Chengmao; Zhu, Yu; Bao, Zeqing; Wang, Xianxue; Liu, Qili

    2018-02-01

    Objective To investigate the efficacy and safety of ondansetron during cesarean section under spinal anesthesia. Methods We sought randomized controlled trials (RCTs) on ondansetron during spinal anesthesia for cesarean section in The Cochrane Library, PubMed, MEDLINE, and Web of Science from their inception to September 2016. Results Altogether, 21 RCTs were included in this study. Meta-analysis showed that the ondansetron group had a lower incidence of nausea/vomiting and bradycardia than the placebo group during cesarean section under spinal anesthesia [relative risk (RR) = 0.43, 95% confidence interval (CI) (0.36, 0.51) and RR = 0.45, 95% CI (0.26, 0.80), respectively]. There were no significant differences in the incidences of pruritus, hypotension, or shivering during cesarean section under spinal anesthesia [RR = 0.92, 95% CI (0.83, 1.02); RR = 0.72 (0.50, 1.06), 95% CI (0.50, 1.06); and RR = 0.89, 95% CI (0.71, 1.11), respectively]. Conclusion Ondansetron effectively reduces the incidences of nausea/vomiting and bradycardia under spinal anesthesia during cesarean section.

  8. [Review of 197 cases of urgent cesarean section performed in 2010 using NICE classification].

    Science.gov (United States)

    Sakoda, Atsushi; Ikuma, Shinichiro; Baba, Mariko; Sato, Masaki; Sumikura, Hiroyuki

    2014-12-01

    NICE (National Institute for Health and Clinical Excellence) of UK introduced a new classification of urgent cesarean section consisting of four categories. We classified 197 cases of urgent cesarean section performed at our institution between April 1st, 2010 and March 31, 2011, using the NICE classification. Clinical records including obstetric record and anesthetic record were reviewed to identify possible cases as candidates of category 1 and 2, from 197 cases. Final classification was then decided at a case conference with four anesthesiologists and one obstetrician. Five cases were classified into category 1, and 51 cases were into category 2. There were 9 cases with umbilical pH < 7.2 among 51 cases of category 2. In these cases, quicker decision to delivery accompanies worse umbilical pH of the delivered neonate. The present review classifying urgent cesarean section using NICE classification revealed that most cases of urgent cesarean section were treated appropriately at our hospital. NICE guideline seems to be useful to improve anesthetic management of urgent cesarean section.

  9. Effectiveness of tranexamic acid on blood loss in patients undergoing elective cesarean section: randomized clinical trial.

    Science.gov (United States)

    Abdel-Aleem, H; Alhusaini, T K; Abdel-Aleem, M A; Menoufy, M; Gülmezoglu, A M

    2013-11-01

    Cesarean section is associated with more blood loss than vaginal delivery. This could increase the risk of morbidity and mortality especially among anemic women. The objective of the trial is to assess the possible effect of tranexamic acid on blood loss during and after elective cesarean section. We conducted a randomized controlled trial at Women's Health Hospital, Assiut University, Assiut, Egypt. All pregnant women with singleton fetus planned to have elective cesarean section at ≥37 wks gestation were randomized to receive 1 g tranexamic acid slowly intravenously over 10 min before elective cesarean section group or not. Blood loss was measured during and for two hours after operation. Any side effects, complications, medications, changes in vital signs and duration of hospital stay were recorded. This study is registered, number ACTRN12612000313831. Seven hundred and forty women were randomized (373 in study group and 367 in control group). Mean total blood loss was 241.6 (SE 6.77) ml in the tranexamic acid group versus 510 (SE 7.72) ml in the control group. The mean drop in hematocrit and hemoglobin levels were statistically significantly lower in the tranexamic acid group than in the control group. There were no statistically or clinically significant differences in other outcomes. Pre-operative use of tranexamic acid is associated with reduced blood loss during and after elective cesarean section. This could be of benefit for anemic women or those who refuse blood transfusion.

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

    DEFF Research Database (Denmark)

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

    1994-01-01

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

  11. Surgical risk index and surgical site infection in postpartum women submitted to cesarean section.

    Directory of Open Access Journals (Sweden)

    Luana Machado Chianca

    2015-01-01

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

  12. The intelligence quotient of school aged children delivered by cesarean section and vaginal delivery

    Science.gov (United States)

    Khadem, Nayereh; Khadivzadeh, Talaat

    2010-01-01

    BACKGROUND: There has always been an asking question with physicians and health staff whether delivery mode can effect on child intelligence. This study was conducted to compare the intelligence quotient (IQ) of school aged children delivered by cesarean section and vaginal delivery in Mashhad, Iran. METHODS: This study conducted in two stages; a cross-sectional section in which 5000 randomly selected children, who were 6-7 years old, attended at 10 Cognitive Examination Posts in Mashhad. The examination was performed by the Exceptional Education and Training Institute affiliated to Ministry of Education for all 6-7 years old children at the entry to the primary school. At the second stage, we selected two matched groups of 189 children who delivered by cesarean section or spontaneous vaginal delivery and then compared their IQ scores. RESULTS: The cesarean delivery group had significantly higher IQ test scores. Maternal and paternal educational levels were related to children’s IQ scores. After adjusting of maternal and paternal education, maternal age and parity, there was not any significant difference between IQ scores of cesarean delivery and natural vaginal delivery groups 101(3.67) vs. 100.7(4.28). CONCLUSIONS: Based on our findings, the association between cesarean deliveries with better cognitive development in children cannot be supported. PMID:21589777

  13. Symptoms of anal and urinary incontinence following cesarean section or spontaneous vaginal delivery.

    Science.gov (United States)

    Altman, Daniel; Ekström, Asa; Forsgren, Catharina; Nordenstam, Johan; Zetterström, Jan

    2007-11-01

    The objective of the study was to compare the prevalence of incontinence disorders in relation with spontaneous vaginal delivery or cesarean section. Two hundred women with spontaneous vaginal deliveries only were compared with 195 women with cesarean deliveries only 10 years after first delivery. When compared with cesarean section, vaginal delivery was associated with an increased frequency of stress urinary incontinence (P = .006) and an increased use of protective pads (P = .008) as well as an increased frequency of fecal urgency (P = .048) and gas incontinence (P = .01). At multivariate regression analysis, mode of delivery showed no significant association with incontinence symptoms other than an increased risk for flatus incontinence in women with a history of obstetric anal sphincter injury (odds ratio 3.1; 95% confidence interval, 1.5 to 8.9). Incontinence symptoms are more common following spontaneous vaginal delivery when compared with cesarean section 10 years after first delivery. However, cesarean section is not associated with a major reduction of anal and urinary incontinence.

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

    Directory of Open Access Journals (Sweden)

    Anıl İçel Saygı

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

  15. Elective Cesarean section at 37 weeks is associated with the higher risk of neonatal complications.

    Science.gov (United States)

    Nakashima, Jun-ichi; Yamanouchi, Sohsaku; Sekiya, Shin-ichiro; Hirabayashi, Masato; Mine, Kenji; Ohashi, Atsushi; Tsuji, Shoji; Kasamatsu, Atsushi; Kanzaki, Hideharu; Hirano, Daishi; Kaneko, Kazunari

    2014-08-01

    Elective Cesarean section performed before 39 weeks of gestation may be associated with increased risk of neonatal complications. We retrospectively investigated differences in the neonatal complication rate between 684 newborns delivered by elective Cesarean section at 37 weeks of gestation (n = 390) and those delivered by the same procedure at 38 weeks (n = 294) between 2006 and 2012 at our hospital in order to ascertain whether adverse outcomes differ between the groups. Newborns delivered at 37 weeks had a significantly higher incidence of neonatal intensive care unit admission (p = 0.03), adverse respiratory complications (p complications such as hyperbirilubinemia, hypoglycemia or bacterial infections. In conclusion, the incidence of neonatal complications was higher in newborns delivered at 37 weeks of gestation than in those delivered at 38 weeks via elective Cesarean section. Thus, the procedure should be scheduled at 38 weeks to improve neonatal outcomes.

  16. 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.

  17. Managing anesthesia for cesarean section in obese patients: current perspectives

    Science.gov (United States)

    Lamon, Agnes M; Habib, Ashraf S

    2016-01-01

    Obesity is a worldwide epidemic. It is associated with increased comorbidities and increased maternal, fetal, and neonatal complications. The risk of cesarean delivery is also increased in obese parturients. Anesthetic management of the obese parturient is challenging and requires adequate planning. Therefore, those patients should be referred to antenatal anesthetic consultation. Anesthesia-related complications and maternal mortality are increased in this patient population. The risk of difficult intubation is increased in obese patients. Neuraxial techniques are the preferred anesthetic techniques for cesarean delivery in obese parturients but can be technically challenging. An existing labor epidural catheter can be topped up for cesarean delivery. In patients who do not have a well-functioning labor epidural, a combined spinal epidural technique might be preferred over a single-shot spinal technique since it is technically easier in obese parturients and allows for extending the duration of the block as required. A continuous spinal technique can also be considered. Studies suggest that there is no need to reduce the dose of spinal bupivacaine in the obese parturient, but there is little data about spinal dosing in super obese parturients. Intraoperatively, patients should be placed in a ramped position, with close monitoring of ventilation and hemodynamic status. Adequate postoperative analgesia is crucial to allow for early mobilization. This can be achieved using a multimodal regimen incorporating neuraxial morphine (with appropriate observations) with scheduled nonsteroidal anti-inflammatory drugs and acetaminophen. Thromboprophylaxis is also important in this patient population due to the increased risk of thromboembolic complications. These patients should be monitored carefully in the postoperative period, since there is increased risk of postoperative complications in the morbidly obese parturients. PMID:27574464

  18. Effects of a Paternal Participation Program during Cesarean Section on Paternal Infant Attachment

    Directory of Open Access Journals (Sweden)

    Hyun Kyoung Kim

    2013-06-01

    Full Text Available PurposeIn this study effects of a paternal participation program during cesarean section on paternal infant attachment were investigate. The experimental treatment was an integrative nursing intervention to promote father to infant attachment.MethodsStudy design was a non-equivalent control group posttest design. The program consisted of emotional support to spouse and father towards infant attachment immediately following cesarean birth. Participants were 66 men, partners of women with normal full term pregnancy having a cesarean section with spinal or epidural anesthesia, (experimental group, 34; control group, 32. The experiment was carried out from August 1 to October 30, 2010. Control group data were obtained from May 1 to June 30, 2012. Posttest was performed 72 hours after cesarean birth. A self-report questionnaire including a paternal attachment instrument was used. Data were analyzed using t-test, propensity score matching, and analysis of covariance with the SPSS/WIN 18.0 program.ResultsTotal score for paternal infant attachment in the experimental group was significantly higher than the control group (p<.001. After matching, significant differences were found between the two groups through all subcategories. Adjusted mean score for paternal infant attachment verified experimental effects.ConclusionResults indicate that this paternal participation program during cesarean section is effective in improving paternal infant attachment.

  19. [An investigation on surgical-site infection among post cesarean section patients with Burkholderia cepacia contaminated ultrasonic couplant].

    Science.gov (United States)

    Wang, Man; Zhang, Lijie; Xia, Shenglin; Wu, Haidong; Zhang, Ruihong; Fan, Mugeng; Wang, Tao

    2014-05-01

    In May 2013, an abnormal increase of surgical-site infection among post cesarean section patients was reported at one hospital in Zhongshan. An investigation was conducted to identify the risk factors and related control measures. All the reported surgical-site infection records among post cesarean section patients were checked. A review of cesarean section schedules of health workers was also performed. An 1 : 2 case-control study was conducted among surgical-site infection cases in May 2013. Microbiologic cultures were performed on 2 surgical site secretion samples and 12 samples from the environment. All the positive isolates were molecular typed by pulsed field gel electrophoresis (PFGE). In May 2013, 4 post cesarean section patients who developed surgical-site infection symptom at one hospital in Zhongshan were reported, with an attack rate as 10.3% (4/39). The emergence time of symptom was 2-3 days after operation. All of the 4 cases underwent an emergency operation. The median time interval for cases from admission to operation was 7.2 hours (ranged from 2 to 9 hours), lower than that seen in the controls, with a median time of 20.8 hours (Z = 5.50, P = 0.03). Two of the 4 cases took type-B ultrasonic inspection 1.4 h and 8.4 h before the operation, and the other two cases took continuous fetal heart monitoring 2 hours before the operation. Skin of the operation area on the 4 cases had been exposed to ultrasonic couplant, without a thorough clean. The proportion of type-B ultrasonic inspection or continuous fetal heart monitoring was much higher in cases than in controls (χ² = 5.19, P = 0.01). Burkholderia cepacia (BC) isolates were discovered from:one surgical site secretion, 2 type-B ultrasonic probe samples, one ultrasonic couplant in use and one ultrasonic couplant unopened. All the isolates were identified as 100% identical by PFGE. The skin of operation area of cesarean section patients had been exposed to BC contaminated ultrasonic couplant without

  20. Antenatal Sonographic Diagnosis and Clinical Significance of Placenta Previa Accreta after Cesarean Section.

    Science.gov (United States)

    Liu, Zhen-Zhen; Wei, Yao; Wang, Ruo-Jiao; Xu, Wen; Shi, Zhi-Min; Dai, Qing

    2017-10-30

    Objective To investigate the clinical and antenatal sonographic characteristics of placenta previa accreta after cesarean section. Methods The data of 21 inpatients diagnosed as placenta previa accreta after cesarean section in PUMC Hospital from 2006 to 2016 were retrospectively reviewed. The clinical and ultrasound features were recorded and compared among three placental accreta groups,including placenta accrete group(n=5),increta group(n=12),and percreta group(n=4). The relationship between the placental thickness at the uterine anterior lower segment level and the blood loss of the following cesarean section was tested. Results Of 21 patients,placenta previa was diagnosed by ultrasound in 20 cases(95.2%) and placenta previa accreta was diagnosed in 9 cases(42.9%). Antenatal ultrasound findings included following signs:loss of "clear zone"(15/18,83.3%),myometrial thinning(12/18,66.7%),abnormal placental lacunae(12/19,63.2%),bladder wall interruption(2/18,11.1%),and uterovesical hypervascularity(4/9,44.4%). Myometrial thinning(J-T=64.000,P=0.036),abnormal placental lacunae(J-T=74.500,P=0.032) and the placental thickness at the uterine anterior lower segment level(U=83.000,P=0.010) showed significant difference among different placenta accreta groups. Placental thickness at the uterine anterior lower segment level showed linear correlation with the blood loss of the following cesarean section(r=0.669,P=0.002). The blood loss of the following cesarean section showed significant difference among different placenta accreta groups(U=118.500,P=0.000). Conclusions The clinical and sonographic manifestations of placenta previa accreta after cesarean section show a spectrum of demographic characteristics. The measurement of thickness of placenta at the anterior lower segment may help the evaluation of the clinical prognosis of this special pathology.

  1. Late preterm birth and previous cesarean section: a population-based cohort study.

    Science.gov (United States)

    Yasseen Iii, Abdool S; Bassil, Kate; Sprague, Ann; Urquia, Marcelo; Maguire, Jonathon L

    2018-02-21

    Late preterm birth (LPB) is increasingly common and associated with higher morbidity and mortality than term birth. Yet, little is known about the influence of previous cesarean section (PCS) and the occurrence of LPB in subsequent pregnancies. We aim to evaluate this association along with the potential mediation by cesarean sections in the current pregnancy. We use population-based birth registry data (2005-2012) to establish a cohort of live born singleton infants born between 34 and 41 gestational weeks to multiparous mothers. PCS was the primary exposure, LPB (34-36 weeks) was the primary outcome, and an unplanned or emergency cesarean section in the current pregnancy was the potential mediator. Associations were quantified using propensity weighted multivariable Poisson regression, and mediating associations were explored using the Baron-Kenny approach. The cohort included 481,531 births, 21,893 (4.5%) were LPB, and 119,983 (24.9%) were predated by at least one PCS. Among mothers with at least one PCS, 6307 (5.26%) were LPB. There was increased risk of LPB among women with at least one PCS (adjusted Relative Risk (aRR): 1.20 (95%CI [1.16, 1.23]). Unplanned or emergency cesarean section in the current pregnancy was identified as a strong mediator to this relationship (mediation ratio = 97%). PCS was associated with higher risk of LPB in subsequent pregnancies. This may be due to an increased risk of subsequent unplanned or emergency preterm cesarean sections. Efforts to minimize index cesarean sections may reduce the risk of LPB in subsequent pregnancies.

  2. Cimethidine pre-anesthetic. A prophylactic method against Mendelson's syndrome in cesarean section

    DEFF Research Database (Denmark)

    Qvist, N; Storm, K

    1983-01-01

    Twenty patients undergoing cesarean section received cimethidine 400 mg intramuscularly as pre-anesthetic approximately 70 minutes prior to gastric aspiration. The average pH was 5.05, as against 2.97 in the control group (p less than 0.01). No significant reduction in the aspirated volumes was o...... in the infants. Hence, cimethidine is a safe and useful pre-anesthetic for patients undergoing cesarean section, irrespective of indication and, consequently, much to be preferred to oral antacids....

  3. [Historical Review of Cesarean Section at King's Maternity Hospital and Midwifery School Zagreb 1908-1918].

    Science.gov (United States)

    Habek, D; Kruhak, V

    2016-04-01

    This article presents a historical review of the performance of 23 cesarean sections at the King’s Maternity Hospital and Midwifery School in Zagreb during the 1908-1918 period. Following prenatal screening by midwives and doctors in the hospital, deliveries in high risk pregnant women were performed at maternity hospitals, not at home. The most common indication for cesarean section was narrowed pelvis in 65.2% of women, while postpartum febrile condition was the most common complication in the puerperium. Maternal mortality due to sepsis after the procedure was 8.69% and overall perinatal mortality was 36.3% (stillbirths and early neonatal deaths).

  4. Timing of elective cesarean section and neonatal morbidity: A randomized controlled trial

    DEFF Research Database (Denmark)

    Glavind, Julie; Kindberg, Sara Fevre; Uldbjerg, Niels

    2012-01-01

    Objective Neonatal complications related to timing of elective cesarean section (ECS) have never been studied in randomized trials. We designed the first randomized trial of timing of ECS and hypothesized a decrease in neonatal admission rate if ECS was scheduled after 39 completed weeks of gesta......Objective Neonatal complications related to timing of elective cesarean section (ECS) have never been studied in randomized trials. We designed the first randomized trial of timing of ECS and hypothesized a decrease in neonatal admission rate if ECS was scheduled after 39 completed weeks...

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

    Directory of Open Access Journals (Sweden)

    Feng XL

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Senturk MB

    2015-07-01

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

  7. Intervention for Postpartum Infections Following Caesarean Section

    Science.gov (United States)

    2016-10-14

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

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

    NARCIS (Netherlands)

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

    2016-01-01

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

  9. The impact of payment source and hospital type on rising cesarean section rates in Brazil, 1998 to 2008.

    Science.gov (United States)

    Hopkins, Kristine; de Lima Amaral, Ernesto Friedrich; Mourão, Aline Nogueira Menezes

    2014-06-01

    High cesarean section rates in Brazilian public hospitals and higher rates in private hospitals are well established. Less is known about the relationship between payment source and cesarean section rates within public and private hospitals. We analyzed the 1998, 2003, and 2008 rounds of a nationally representative household survey (PNAD), which includes type of delivery, where it took place, and who paid for it. We construct cesarean section rates for various categories, and perform logistic regression to determine the relative importance of independent variables on cesarean section rates for all births and first births only. Brazilian cesarean section rates were 42 percent in 1998 and 53 percent in 2008. Women who delivered publicly funded births in either public or private hospitals had lower cesarean section rates than those who delivered privately financed deliveries in public or private hospitals. Multivariate models suggest that older age, higher education, and living outside the Northeast region all positively affect the odds of delivering by cesarean section; effects are attenuated by the payment source-hospital type variable for all women and even more so among first births. Cesarean section rates have risen substantially in Brazil. It is important to distinguish payment source for the delivery to have a better understanding of those rates. © 2014 Wiley Periodicals, Inc.

  10. Neonatal outcome following elective cesarean section beyond 37 weeks of gestation: a 7-year retrospective analysis of a national registry

    NARCIS (Netherlands)

    Wilmink, Freke A.; Hukkelhoven, Chantal W. P. M.; Lunshof, Simone; Mol, Ben Willem J.; van der Post, Joris A. M.; Papatsonis, Dimitri N. M.

    2010-01-01

    OBJECTIVE: We sought to evaluate number and timing of elective cesarean sections at term and to assess perinatal outcome associated with this timing. STUDY DESIGN: We conducted a recent retrospective cohort study including all elective cesarean sections of singleton pregnancies at term (n = 20,973)

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

    Science.gov (United States)

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

    2016-11-22

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

  12. The changing indications and rates of cesarean section in one academic center over a 16-year period (1997-2012).

    Science.gov (United States)

    Lurie, Samuel; Shalev, Amir; Sadan, Oscar; Golan, Abraham

    2016-08-01

    To compare trends and rates of cesarean section delivery by indication in one academic center. A retrospective analysis of the indications of all cesarean sections performed in Edith Wolfson Medical Center, Holon, Israel, a tertiary healthcare university facility, during 1997-2012 was done. Each delivery was assigned to the primary indication noted for that pregnancy, regardless of other indications reported. Whenever more than one indication was present, the principle indication chosen by the attending obstetrician was chosen for the analysis. The cesarean section rate gradually rose from 15.29% in 1997 to 21.10% in 2012, with an overall cesarean section rate of 20.66%. The cesarean section rate between 1997 and 2000 was 17.52%, between 2001 and 2004 was 18.5%, between 2005 and 2009 was 22.86%, and between 2009 and 2012 was 22.07% (p cesarean section (26.0%), non-reassuring fetal heart rate pattern (18.1%), malpresentation (16.9%), labor dystocia (8.8%), and suspected macrosomia (7.2%). Previous cesarean section persistently increased and was the leading indication throughout the years. Any attempt to reverse this trend must be based on reduction of the primary cesarean section rate. Copyright © 2016. Published by Elsevier B.V.

  13. Intention for Cesarean Section Versus Vaginal Delivery Among Pregnant Women in Isfahan: Correlates and Determinants.

    Science.gov (United States)

    Shams-Ghahfarokhi, Zahra; Khalajabadi-Farahani, Farideh

    2016-01-01

    Iran has the second highest rate of cesarean section in the world. the corresponding rate in the third metropolitan city of Iran, Isfahan, is even higher. This paper aimed to assess correlates and determinants of intention for cesarean section versus normal vaginal delivery (NVD) among pregnant women in Isfahan. A study was conducted among 400 pregnant women aged 18-38 years, with gestational age of 24-40 weeks who attended labor clinics of nine hospitals in Isfahan during June and July 2014. Probability proportional to size was used to estimate the number of cases required to be selected for each hospital. T-test, chi-square and logistic regression analysis were employed to analyze the data. Mean age of women was 26.6±4.4 years. Multivariate analysis identified selected factors as determinants of intention for CS. These were "the role of physician" (OR=1.33, pcesarean section" and "individualism" influence CS decision through subjective norm. Choosing cesarean section voluntarily is a multifaceted decision which is shaped by various factors; hence, comprehensive interventions are suggested to discourage voluntary cesarean section. These interventions need to encompass changes in physicians' role, social norms, body image and correcting misperceptions among women towards CS and NVD during prenatal courses.

  14. Cesarean section intraoperative blood loss and mode of placental separation.

    Science.gov (United States)

    Ramadani, H

    2004-11-01

    To investigate whether manual removal of the placenta is associated with significant blood loss compared with spontaneous separation of the placenta during cesarean delivery. A randomized prospective study of 400 women with normal pregnancies undergoing cesarean delivery at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Patients were randomly assigned to the study group, (manual placental removal, n=200) or the control group (spontaneous placental separation, n=200). Operative blood loss was assessed by the volumetric and gravimetric methods. Hemoglobin levels were evaluated the third postoperative day and patient's postoperative complications were recorded. The mean+/-S.D. amount of blood loss associated with manual and spontaneous removal of the placenta was 713+/-240 and 669+/-253 ml, respectively. This difference was statistically significant (P=0.04). There was a postoperative decrease in hemoglobin levels in both groups. Preoperative hemoglobin levels were 11.6+/-3 g/dl in the study group and 11.2+/-1.1 g/dl in the control group, and the difference was statistically significant (P=0.006). The postoperative hemoglobin levels at day 3 were 9.0+/-1.2 g/dl in the study group and 9.9+/-1.2 g/dl in the control group (P=0.003), also a statistically significant difference. The incidence of endometritis, wound infection, and need for blood transfusion was similar in the two groups. Manual delivery of the placenta was significantly associated with greater operative blood loss and greater decrease in postoperative hemoglobin levels, but with shorter operative time compared with spontaneous placental separation. No difference in postoperative complications was noted between the groups.

  15. Association between maternal death and cesarean section in Latin America: A systematic literature review.

    Science.gov (United States)

    Fahmy, Walid Makin; Crispim, Cibele Aparecida; Cliffe, Susan

    2018-04-01

    it is critically important to explore a possible relationship between cesarean section and maternal mortality in Latin America, where the highest cesarean section rates in the world are found. Our aim was to conduct a systematic literature review on the relationship between maternal death and caesarean section in Latin America. we undertook a systematic review through six electronic databases. Studies that reported any association analysis between maternal mortality and the mode of delivery in Latin America were included. Papers that fulfilled the inclusion criteria were then read fully, and a quality assessment was conducted with the PROMPT tool. seven articles were identified for final analysis, all of which were observational studies. Most of the studies were retrospective (6) and one was prospective. Of the retrospective studies, 3 were case control and 3 were cross-sectional. Most of the publications on this topic suggest that there may be an increased risk of maternal mortality with cesarean section compared with vaginal birth (odds ratio ranging from 1.6 to 7.08). However, it is evident that there is a lack of studies with this subject, especially those that take into account the differences in risk between women delivered by cesarean section or by vaginal birth. most of the articles showed that there may be an increased risk of maternal mortality with cesarean section compared with vaginal birth. However, it is clear that there is a limited number of studies published on this issue. Additional studies with a better methodological design should be conducted. Copyright © 2018 Elsevier Ltd. All rights reserved.

  16. Vesicocutaneus fistula after cesarean section-a curious complication: Case report and review.

    Science.gov (United States)

    Tatar, Burak; Erdemoğlu, Ebru; Soyupek, Sedat; Yalçın, Yakup; Erdemoğlu, Evrim

    2016-03-01

    Vesicocutaneous fistulas are very rare pathologies in the urinary tract. We present the second case of a vesicocutaneus fistula after cesarean section, and discuss strategies for prevention, diagnosis, and treatment of this exceptional complication. A woman with a vesicocutaneous fistula after cesarean delivery was admitted and diagnostic tests including fluoroscopy, magnetic resonance imaging (MRI), and reconstructed MRI revealed the fistula tract and an urachal anomaly. The patient was treated through excision of the fistula tract. Laparotomy should be performed carefully, and the surgeon should be aware of the urachus. Inadvertent trauma to the urachus during laparotomy might cause serious unexpected complications. Possible etiologic factors for vesicocutaneous fistulae, prevention, and treatment methods are discussed.

  17. [Postpartum hemorrhage and pregnancy induced hypertension during emergency lower segment cesarean section: dexmedetomidine to our rescue].

    Science.gov (United States)

    Hariharan, Uma

    Dexmedetomidine is a highly selective α-2 agonist which has recently revolutionized our anesthesia and intensive care practice. An obstetric patient presented for emergency cesarean delivery under general anesthesia, with pre-eclampsia and postpartum hemorrhage. In carefully selected cases with refractory hypertension and postpartum hemorrhage, dexmedetomidine can be used for improving overall patient outcome. It was beneficial in controlling both the blood pressure and uterine bleeding during cesarean section in our patient. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Ugo Indraccolo

    2015-06-01

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

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

    Science.gov (United States)

    Lee, Amy Su May; Kirkman, Maggie

    2008-05-01

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

  20. Anesthesia for cesarean section in a patient with Guillain-Barre syndrome: Case report.

    Science.gov (United States)

    Volquind, Daniel; Fellini, Roberto Taboada; Rose, Giana Lucho; Tarso, Gabriel Pedro

    2013-01-01

    Guillain-Barre syndrome during pregnancy is considered a rare neurological complication, and there is no consensus in literature for anesthetic management for cesarean section in such patients. The objective of this paper is to report the case of a pregnant woman with Guillain-Barre syndrome undergoing cesarean section. Female patient, 22-year old, 35 weeks and 5 days of gestation, undergoing cesarean section, hospitalized, reporting decreased strength and lower limb paresthesias. Cerebrospinal fluid (CSF) analysis showed increased protein (304 mg.dL(-1)) without increased cellularity. The anesthetic technique used was general anesthesia induced with propofol (1.5 mg.kg(-1)) and maintained with 2% sevoflurane in oxygen and fentanyl (3 μg.kg(-1)). The procedure was uneventful for both mother and neonate. The patient was discharged 10 days after admission, after progressive improvement of neurological symptoms. The anesthetic technique for pregnant women with Guillain-Barre syndrome requiring cesarean section remains at the discretion of the anesthesiologist, who should be guided by the clinical conditions and comorbidities of each patient. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  1. Dilatation or no dilatation of the cervix during cesarean section (Dondi Trial): a randomized controlled trial.

    Science.gov (United States)

    Kirscht, Jade; Weiss, Christel; Nickol, Jana; Berlit, Sebastian; Tuschy, Benjamin; Hoch, Benjamin; Trebin, Amelie-Verena; Große-Steffen, Thomas; Sütterlin, Marc; Kehl, Sven

    2017-01-01

    To assess the effects of mechanical dilatation of the cervix during cesarean section on postoperative morbidity. A total of 447 women with elective cesarean section were included in the Dondi trial (Dilatation or no dilatation of the cervix during cesarean section). The primary outcome measure of this randomized controlled trial was postpartum hemorrhage (PPH) within 6 weeks. Infectious morbidity (puerperal fever, endometritis, wound infection, and urinary tract infection), blood loss (need for blood transfusion or change in hemoglobin levels), and operating time were also evaluated. The rate of PPH within 6 weeks was not different between the two groups [dilatation group: 5 (2.4 %), no dilatation group: 3 (1.2 %), p = 0.479]. Infectious morbidity, blood loss, and operating time were not diverse as well. The only significant difference between the two groups was the rate of retained products of conception with fewer cases after cervical dilatation (0 versus 6.2 %, p cesarean section compared with no dilatation of the cervix did not influence the risk of postpartum hemorrhage. However, there were fewer cases with retained products of conception after dilatation.

  2. Pulmonary embolism caused by ovarian vein thrombosis during cesarean section: a case report.

    Science.gov (United States)

    Oda, Yutaka; Fujita, Michie; Motohisa, Chika; Nakata, Shinichi; Shimada, Motoko; Komatsu, Ryushi

    2018-01-01

    Ovarian vein thrombosis is a rare complication of pregnancy. The representative complaints of patients with ovarian vein thrombosis are abdominal pain and fever. In some cases, however, fatal pulmonary embolism may develop. We report a case of pulmonary embolism presenting with severe hypotension and loss of consciousness during cesarean section possibly caused by ovarian vein thrombosis. A 25-year-old woman at 38 weeks 4 days of gestation was scheduled for repeat cesarean section. Her past history was unremarkable, and the progress of her pregnancy was uneventful. She did not experience any symptoms indicative of deep vein thrombosis. Cesarean section was performed under spinal anesthesia, and a healthy newborn was delivered. After removal of the placenta, she suddenly developed dyspnea, hypotension, and loss of consciousness with decreased peripheral oxygen saturation. Blood pressure, heart rate, and oxygen saturation recovered after tracheal intubation and mechanical ventilation with oxygen. Postoperative computed tomography revealed no abnormality in the brain or in the pulmonary artery, but a dilated right ovarian vein with thrombi, extending up to the inferior vena cava, was found. A diagnosis of pulmonary embolism caused by ovarian vein thrombosis was made, and heparin was administered. The tracheal tube was removed on the first postoperative day. Her postoperative course was uneventful, and she was discharged with no complications. Fatal pulmonary embolism might be caused by ovarian vein thrombosis during cesarean section. Careful and continuous observation of the patient after delivery and prompt treatment are important.

  3. Identification of barriers and facilitators for optimal cesarean section care : Perspective of professionals

    NARCIS (Netherlands)

    Melman, Sonja; Schreurs, Rachel Hellen Petra; Dirksen, Carmen Desiree; Kwee, Anneke; Nijhuis, Jan Gerrit; Smeets, Nicol Anna Cornelia; Scheepers, Hubertina Catharina Johanna; Hermens, Rosella Petronella Maria Gemma

    2017-01-01

    Background: The cesarean section (CS) rate has increased over recent decades with poor guideline adherence as a possible cause. The objective of this study was to explore barriers and facilitators for delivering optimal care as described in clinical practice guidelines.  Methods: Key recommendations

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

    Directory of Open Access Journals (Sweden)

    Amr H. Yehia

    2014-03-01

    Conclusions: Tranexamic acid can be used safely to reduce blood loss during cesarean section. Reduced blood loss after tranexamic acid was associated with improvement of post-operative hemoglobin, hematocrit and with reduction of post-partum need for iron replacement.

  5. [Acute pseudo-obstruction of the colon (Ogilvie syndrome) after Cesarean section].

    Science.gov (United States)

    Beer, P; Pescatore, P A; Desbiolles, A; Bader, P

    1994-01-01

    In a 27-year-old woman a spontaneous perforation of the bowel developed after cesarean section. The clinical picture, pathophysiological aspects and prophylactic treatment of Ogilvie's syndrome are discussed. This rare but serious complication could have been avoided if the clinical picture and its simple conservative treatment had been known.

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

    NARCIS (Netherlands)

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

    2016-01-01

    Aim of this article is to examine if we could identify factors that predict cesarean section and instrumental vaginal delivery in women who had a successful external cephalic version. We used data from a previous randomized trial among 25 hospitals and their referring midwife practices in the

  7. Intention for Cesarean Section Versus Vaginal Delivery Among Pregnant Women in Isfahan: Correlates and Determinants

    Science.gov (United States)

    Shams-Ghahfarokhi, Zahra; Khalajabadi-Farahani, Farideh

    2016-01-01

    Background: Iran has the second highest rate of cesarean section in the world. the corresponding rate in the third metropolitan city of Iran, Isfahan, is even higher. This paper aimed to assess correlates and determinants of intention for cesarean section versus normal vaginal delivery (NVD) among pregnant women in Isfahan. Methods: A study was conducted among 400 pregnant women aged 18–38 years, with gestational age of 24–40 weeks who attended labor clinics of nine hospitals in Isfahan during June and July 2014. Probability proportional to size was used to estimate the number of cases required to be selected for each hospital. T-test, chi-square and logistic regression analysis were employed to analyze the data. Results: Mean age of women was 26.6±4.4 years. Multivariate analysis identified selected factors as determinants of intention for CS. These were “the role of physician” (OR=1.33, pcesarean section” and “individualism” influence CS decision through subjective norm. Conclusion: Choosing cesarean section voluntarily is a multifaceted decision which is shaped by various factors; hence, comprehensive interventions are suggested to discourage voluntary cesarean section. These interventions need to encompass changes in physicians’ role, social norms, body image and correcting misperceptions among women towards CS and NVD during prenatal courses. PMID:27921002

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2000-03-01

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

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

    International Nuclear Information System (INIS)

    Ryu, Chang Woo; Kim, Hee Jin

    2000-01-01

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

  10. Maternal and perinatal outcomes of delivery after a previous Cesarean section in Enugu, Southeast Nigeria: a prospective observational study.

    Science.gov (United States)

    Ugwu, George O; Iyoke, Chukwuemeka A; Onah, Hyacinth E; Egwuatu, Vincent E; Ezugwu, Frank O

    2014-01-01

    Obstetricians in developing countries appear generally reluctant to conduct vaginal delivery in women with a previous Cesarean because of lack of adequate facilities for optimal fetomaternal monitoring. To describe delivery outcomes among women with one previous Cesarean section at a tertiary hospital in Southeast Nigeria. This was a prospective observational study to determine maternal and perinatal outcomes of attempted vaginal birth after Cesarean sections (VBAC) following one previous Cesarean section. Analysis was done with SPSS statistical software version 17.0 for Windows using descriptive and inferential statistics at 95% level of confidence. Two thousand six hundred and ten women delivered in the center during the study period, of whom 395 had one previous Cesarean section. A total of 370 women with one previous Cesarean section had nonrecurrent indications, of whom 355 consenting pregnant women with one previous Cesarean section were studied. A majority of the women (320/355, 90.1%) preferred to have vaginal delivery despite the one previous Cesarean section. However, only approximately 54% (190/355) were found suitable for trial of VBAC, out of whom 50% (95/190 had successful VBAC. Ninety-five women (50.0%) had failed attempt at VBAC and were delivered by emergency Cesarean section while 35 women (9.8%) had emergency Cesarean section for other obstetric indications (apart from failed VBAC). There was no case of uterine rupture or neonatal and maternal deaths recorded in any group. Apgar scores of less than 7 in the first minute were significantly more frequent amongst women who had vaginal delivery when compared to those who had elective repeat Cesarean section (P=0.03). Most women who had one previous Cesarean delivery chose to undergo trial of VBAC, although only about half were considered suitable for VBAC. The maternal and fetal outcomes of trial of VBAC in selected women with one previous Cesarean delivery for non-recurrent indications were good

  11. Clinical Relevance and Treatment Selection of Ureteral Injury After Cesarean Section.

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    Lo, Tsia-Shu; Wijaya, Tomy; Lo, Liang-Ming; Kao, Chuan-Chi; Wu, Pei-Ying; Cortes, Eileen Feliz M; Huang, Shih Yin; Lin, Chih Hui

    2016-01-01

    The aim of this case series was to report the clinical relevance and management outcomes of ureteral injuries acquired secondary to cesarean section. This was a retrospective case series from January 2007 to September 2014. Description of the patients' characteristics, diagnostic tools for investigation, management, and postoperative follow-up was conducted on postcesarean section patients who developed symptoms of urine leakage after cesarean section and necessitated secondary surgery for ureteral injury. Descriptive statistics was used for demographics and operative data. A total of 5619 cases were managed by cesarean section during the study period. Six (0.107%; 95% confidence interval [CI], 0.1069%-0.1071%) patients had ureteral injury related to the cesarean section. Of 6 cases, 3 (0.053%; 95% CI, 0.0529%-0.0531%) had ureterouterine fistula. Three cases were managed by ureteroneocystostomy, 1 by ureteroneocystostomy with Boari flap, 1 by transureteroureterostomy, and the other one by ureteral stenting via ureterocystoscopy. Three patients had immediate operation because of an acute abdomen and 3 patients had delayed operation. The left ureter was the most common site of ureteral injury (5/6). The postoperative course was uneventful for all cases. Continuous urinary leakage and acute abdominal distention associated with fluid accumulation after emergency cesarean section should be considered as "red flag" symptoms of ureteral injury and ureterouterine fistulae complications. Delayed management for ureteral repair may not be associated with bad outcomes for management of ureterouterine fistula. Delayed management was associated with less blood loss, less operating time, and acceptable outcome among patients with ureterouterine fistulae when the renal function is not compromised.

  12. Prevalence of urinary incontinence and pelvic floor muscle dysfunction in primiparae two years after cesarean section: cross-sectional study.

    Science.gov (United States)

    Barbosa, Angélica Mércia Pascon; Marini, Gabriela; Piculo, Fernanda; Rudge, Cibele Vieira Cunha; Calderon, Iracema Mattos Paranhos; Rudge, Marilza Vieira Cunha

    2013-01-01

    There is uncertainty in the literature regarding the theory that obstetric events and pelvic floor injuries give rise to lower risk of subsequent urinary incontinence among women delivering via cesarean section than among women delivering vaginally. The objective of this study was to assess the two-year postpartum prevalence of urinary incontinence and pelvic floor muscle dysfunction and the factors responsible for them. Cross-sectional study, conducted in a public university. 220 women who had undergone elective cesarean section or vaginal childbirth two years earlier were selected. Their urinary incontinence symptoms were investigated, and their pelvic floor muscle dysfunction was assessed using digital palpation and a perineometer. The two-year urinary incontinence prevalences following vaginal childbirth and cesarean section were 17% and 18.9%, respectively. The only risk factor for pelvic floor muscle dysfunction was weight gain during pregnancy. Body mass index less than 25 kg/m 2 and normal pelvic floor muscle function protected against urinary incontinence. Gestational urinary incontinence increased the risk of two-year postpartum urinary incontinence. Gestational urinary incontinence was a crucial precursor of postpartum urinary incontinence. Weight gain during pregnancy increased the subsequent risk of pelvic floor muscle dysfunction, and elective cesarean section did not prevent urinary incontinence.

  13. Prevalence of urinary incontinence and pelvic floor muscle dysfunction in primiparae two years after cesarean section: cross-sectional study

    Directory of Open Access Journals (Sweden)

    Angélica Mércia Pascon Barbosa

    Full Text Available CONTEXT AND OBJECTIVE There is uncertainty in the literature regarding the theory that obstetric events and pelvic floor injuries give rise to lower risk of subsequent urinary incontinence among women delivering via cesarean section than among women delivering vaginally. The objective of this study was to assess the two-year postpartum prevalence of urinary incontinence and pelvic floor muscle dysfunction and the factors responsible for them. DESIGN AND SETTING Cross-sectional study, conducted in a public university. METHODS 220 women who had undergone elective cesarean section or vaginal childbirth two years earlier were selected. Their urinary incontinence symptoms were investigated, and their pelvic floor muscle dysfunction was assessed using digital palpation and a perineometer. RESULTS The two-year urinary incontinence prevalences following vaginal childbirth and cesarean section were 17% and 18.9%, respectively. The only risk factor for pelvic floor muscle dysfunction was weight gain during pregnancy. Body mass index less than 25 kg/m 2 and normal pelvic floor muscle function protected against urinary incontinence. Gestational urinary incontinence increased the risk of two-year postpartum urinary incontinence. CONCLUSION Gestational urinary incontinence was a crucial precursor of postpartum urinary incontinence. Weight gain during pregnancy increased the subsequent risk of pelvic floor muscle dysfunction, and elective cesarean section did not prevent urinary incontinence.

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

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    Feng, Xing Lin; Wang, Ying; An, Lin; Ronsmans, Carine

    2014-01-01

    Objective To review the current knowledge on the prevalence, reasons, and consequences of cesarean sections in the People’s Republic of China. Methods Peer-reviewed articles were systematically searched on PubMed. The following Chinese databases were comprehensively searched: the China National Knowledge Infrastructure, Wanfang, and the VIP information. The databases were searched from inception to September 1, 2013. Two reviewers independently screened the titles and abstracts for eligibility. Full texts of eligible papers were reviewed, where relevant references were hand-searched and reviewed. Findings Sixty articles were included from PubMed, 17 articles were intentionally picked out from Chinese journals, and five additional articles were added, for a total of 82 articles for the analysis. With a current national rate near 40%, the literature consistently reported a rapid rise of cesarean sections in the People’s Republic of China in the past decades, irrespective of where people lived or their socioeconomic standing. Nonclinical factors were considered as the main drivers fueling the rise of cesareans in the People’s Republic of China. There was a lively debate on whether women’s preferences or providers’ distorted financial incentives affected the rise in cesarean sections. However, recent evidence suggests that it might be the People’s Republic of China’s health development approach – focusing on specialized care and marginalizing primary care – that is playing a role. Although 30 articles were identified studying the consequences of cesareans, the methodologies are in general weak and the themes are out of focus. Conclusion The overuse of cesareans is rising alarmingly in the People’s Republic of China and has become a real public health problem. No consensus has been made on the leverage factors that drive the cesarean epidemic, particularly for those nonclinical factors. The more macro level structural factors may have played a part

  15. ED50 of intrathecal ropivacaine for cesarean section under prophylactic infusion of phenylephrine: A consort study.

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    Zhang, Wangping; Wu, Hanbin

    2017-11-01

    Studies have reported that prophylactic continuous infusion of phenylephrine during spinal anesthesia for cesarean section can decrease the spread of local anesthetics. We investigated the ED50 of intrathecal hyperbaric ropivacaine in parturient women undergoing cesarean section under prophylactic infusion of phenylephrine. Sixty parturient women were allocated into 2 groups in this prospective study. Group P received 0.5 mL kg h of phenylephrine (5 mg/50 mL) at the start of intrathecal injection, and Group C (control group) received the same volume of saline. The dose of intrathecal ropivacaine for each subject was decided through up-down allocation method. The initial dose was set as 7.5 mg. Successful anesthesia was defined as the level of T6 or above achieved within 15 minutes after intrathecal injection and no additional epidural drug or venous analgesia to complete operation. The Massey formula was applied to calculate the ED50 of intrathecal ropivacaine in both groups. The ED50 of hyperbaric ropivacaine determined by up-and-down method was 7.2 mg (95% confidence interval (CI), 6.8-7.6 mg) in the Group P, and 6.8 mg (95% CI, 6.4-7.2 mg) in the Group C, there was significant difference between the 2 groups (P cesarean section. The ED50 of intrathecal hyperbaric ropivacaine is 7.2 mg when phenylephrine is prophylactic infused to prevent spinal induced hypotension in cesarean section, and more ropivacaine demands on spinal anesthesia for cesarean section (www.chictr.org.cn, registration number: ChiCTR-RIC-17011650).

  16. Cesarean Section and Interferon-Induced Helicase Gene Polymorphisms Combine to Increase Childhood Type 1 Diabetes Risk

    Science.gov (United States)

    Bonifacio, Ezio; Warncke, Katharina; Winkler, Christiane; Wallner, Maike; Ziegler, Anette-G.

    2011-01-01

    OBJECTIVE The incidence of type 1 diabetes is increasing. Delivery by cesarean section is also more prevalent, and it is suggested that cesarean section is associated with type 1 diabetes risk. We examine associations between cesarean delivery, islet autoimmunity and type 1 diabetes, and genes involved in type 1 diabetes susceptibility. RESEARCH DESIGN AND METHODS Cesarean section was examined as a risk factor in 1,650 children born to a parent with type 1 diabetes and followed from birth for the development of islet autoantibodies and type 1 diabetes. RESULTS Children delivered by cesarean section (n = 495) had more than twofold higher risk for type 1 diabetes than children born by vaginal delivery (hazard ratio [HR] 2.5; 95% CI 1.4–4.3; P = 0.001). Cesarean section did not increase the risk for islet autoantibodies (P = 0.6) but was associated with a faster progression to diabetes after the appearance of autoimmunity (P = 0.015). Cesarean section–associated risk was independent of potential confounder variables (adjusted HR 2.7;1.5–5.0; P = 0.001) and observed in children with and without high-risk HLA genotypes. Interestingly, cesarean section appeared to interact with immune response genes, including CD25 and in particular the interferon-induced helicase 1 gene, where increased risk for type 1 diabetes was only seen in children who were delivered by cesarean section and had type 1 diabetes–susceptible IFIH1 genotypes (12-year risk, 9.1 vs. cesarean section may be linked to viral responses in the preclinical autoantibody-positive disease phase. PMID:22110093

  17. Comparing Quality of Life in Women after Vaginal Delivery and Cesarean Section

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    Mohammad Mahdi Majzoobi

    2014-10-01

    Full Text Available Background & aim: Postpartum period is accompanied by significant changes in women’s quality of life. These alterations can affect the health of mothers and children. Considering the importance of postnatal quality of life and its different contributing factors, this study aimed to compare women’s quality of life after vaginal delivery and cesarean section. Methods:This retrospective cohort study included a random sample of 2100 women, referring to Hamadan health care centers for congenital hypothyroidism screening or infant vaccination. The participants’ quality of life was examined, using Short Form-36 (SF-36 questionnaire, evaluating five periods of time including one week, two months, four months, six months, and one year after delivery (either vaginal or cesarean delivery. Data were analyzed using t-test. Results: Quality of life was significantly higher in women with vaginal delivery, compared to women with cesarean section in all periods including one week (68.77 vs. 42.44, two months (69.11 vs. 54.76, four months (78.19 vs. 53.02, six months (75.62 vs. 54.94,and one year(78.43 vs. 53.77 after delivery. Conclusion: Considering women’s higher quality of life after vaginal delivery, compared to cesarean section, it seems that vaginal delivery is a safer and less expensive option, which is recommended for all pregnant women.

  18. Prevalence and risk factors for chronic pain following cesarean section: a prospective study.

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    Jin, Juying; Peng, Lihua; Chen, Qibin; Zhang, Dong; Ren, Li; Qin, Peipei; Min, Su

    2016-10-18

    Chronic post-surgical pain (CPSP) remains a major clinical problem which may be associated with impaired activities of daily life and decreased health-related quality of life. Although cesarean section is one of the most commonly performed operations, chronic pain after cesarean delivery has not been well-studied. The purpose of this prospective study was to assess the incidence and risk factors of chronic pain at 3, 6 and 12 months after cesarean delivery. We prospectively investigated preoperative demographic and psychological factors, intraoperative clinical factors, and acute postoperative pain in a cohort of 527 women undergoing cesarean section. The women were interviewed and completed pain questionnaires after 3, 6 and 12 months. Questions were about pain intensity, frequency, and location, as well as medical treatment and impact on daily living. The incidence of CPSP at 3, 6 and 12 months after cesarean section was 18.3 %, 11.3 % and 6.8 %, respectively. Most of the women with CPSP experienced mild pain at rest. The incidence of moderate and severe pain on movement was high at 3 month, and then has a significant decrease at 6 and 12 months. CPSP had a negative influence on the activities of daily living. Independent predictors of CPSP at 3 months included higher average pain intensity on movement within 24 h postoperatively, preoperative depression, and longer duration of surgery. At 6 months, more severe pain during movement within 24 h of surgery and preoperative depression were predictive of pain persistence. And 12 months after surgery, only higher average pain score on movement within 24 h following cesarean section was found to be significant associated with CPSP. The three models all showed moderate discrimination and good calibration for the prediction of CPSP at 3, 6 and 12 months postoperatively. CPSP was not rare in women undergoing cesarean section. Patients with more intense of acute postoperative pain on movement, preoperative

  19. Urinary tract injuries during cesarean section in patients with morbid placental adherence: retrospective cohort study.

    Science.gov (United States)

    Alanwar, Ahmed; Al-Sayed, Helmy M; Ibrahim, Ahmed M; Elkotb, Ahmed M; Abdelshafy, Ahmed; Abdelhadi, Rasha; Abbas, Ahmed M; Abdelmenam, Hend S; Fares, Tamer; Nossair, Wael; Abdallah, Ameer A; Sabaa, Haitham; Nawara, Maii

    2017-12-03

    The purpose of this study is to evaluate the cases of lower urinary tract injuries during cesarean section with or without hysterectomy in cases with morbid placental adherence. This record based retrospective study was conducted at Ain Shams University Maternity Hospital in Cairo, Egypt during the period between January 2014 and December 2016. It included all patients who had urinary tract injuries during cesarean section with or without hysterectomy in the cases with morbid placental adherence and they were collected from files of pregnant women who were admitted at hospital planned for termination of pregnancy. Patients were enrolled in four groups, Group 1: cases without urinary tract injuries. Group 2: cases with injuries to the bladder. Group 3: cases with injuries of the ureter. Group 4: cases with injuries to the bladder and ureter. This study gave us new information about the incidence of urinary tract injuries during cesarean section with morbid adherence placenta was 21.7% (Bladder 11.7%, Ureter 4.7%, and bladder with ureter 5.3%). There were various types of repair of urinary tract injury, as the following, bladder repair 10.8%, ureteric catheterization 0.9%, ureterovesical repair or reimplantation 1.5%, bladder repair and ureterovesical 1.2%, bladder repair and ureteric catheterization 2.3%, ureteric catheterization and ureterovesical 1.5 and 6.4% of cases needed urologic consultations. There is a real relation between urinary tract injury and obesity (55.3%). Bladder invasion was found in only 26.9% of all cases according to sonography findings. Most of the cases were delivered by cesarean section in 67.5%, and the remainders were delivered by cesarean hysterectomy 32.5%. About 96.5% of cases needed a blood transfusion. The morbid adherent placenta is still a challenge, which faces us as obstetricians, due to high morbidity and mortality. A multidisciplinary team is mandatory to avoid complications.

  20. Nonremoval of an abnormally invasive placenta at cesarean section with postoperative uterine artery embolization.

    Science.gov (United States)

    Chung, Man Y; Cheng, Yvonne K Y; Yu, Simon C H; Sahota, Daljit S; Leung, Tak Y

    2013-11-01

    To evaluate the outcome of three different modes of management of abnormally invasive placenta over a 6-year period. Retrospective cohort study. Tertiary hospital in Hong Kong. In 39 757 deliveries, 25 cases of abnormally invasive placenta were identified at cesarean section. Identification of cases by hospital database and review of medical records. Blood loss, blood transfusion requirement, operative time, duration of hospital stay, secondary postpartum hemorrhage and endometritis. Six women were managed by leaving the placenta in situ and by postoperative uterine artery embolization. Ten women were managed by an extirpative approach and nine women with direct cesarean hysterectomy. The success rate of nonremoval of the placenta with uterine artery embolization was 4/6 (67%). The intraoperative blood loss, blood transfusion requirements and operation times were lowest in the group with nonremoval of the placenta, although a higher secondary complication rate and a longer hospital stay followed. Nonremoval of an abnormally invasive placenta at cesarean section and prophylactic postoperative uterine artery embolization are an alternative to elective cesarean hysterectomy. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

  1. Chylothorax as a rare complication of acute pancreatitis in a 25-year-old woman after cesarean section.

    Science.gov (United States)

    Smędra, A; Barzdo, M; Krupińska, J; Klemm, J; Machała, W; Szram, S; Berent, J

    2015-01-01

    The paper presents the case of a 25-year-old woman who underwent cesarean section for gynecological indications in the 37(th) week of her second pregnancy. The perioperative course was uncomplicated, but one day later the general condition of the patient suddenly deteriorated: she developed respiratory disorders requiring intubation and treatment in an intensive care unit. On the 6(th) day after the surgery, the patient was diagnosed with acute pancreatitis. Appropriate conservative treatment was instituted, resulting in a gradual improvement of her condition. On the 13(th) postoperative day, a cardiac arrest in asystole occurred, with no response to the undertaken resuscitation procedures. An autopsy performed in the Department of Forensic Medicine in Łódź revealed, among other findings, acute pancreatitis with enzymatic necrosis of the adipose tissue, a significant accumulation of lymph in both pleural cavities, and pulmonary atelectasis. As demonstrated by the analysis of the case, chylothorax had most probably developed in the course of acute pancreatitis which was a complication of the cesarean section. Consequently, the prosecutor opened an investigation into the case under Article 155 of the Polish Penal Code to assess the appropriateness of medical management. The medico-legal opinion was issued by experts from outside the Department of Forensic Medicine in Łódź. In their view, the medical management of the patient was correct.

  2. Chylothorax as a rare complication of acute pancreatitis in a 25-year-old woman after cesarean section

    Directory of Open Access Journals (Sweden)

    Anna Smędra

    2016-03-01

    Full Text Available The paper presents the case of a 25-year-old woman who underwent cesarean section for gynecological indications in the 37th week of her second pregnancy. The perioperative course was uncomplicated, but one day later the general condition of the patient suddenly deteriorated: she developed respiratory disorders requiring intubation and treatment in an intensive care unit. On the 6th day after the surgery, the patient was diagnosed with acute pancreatitis. Appropriate conservative treatment was instituted, resulting in a gradual improvement of her condition. On the 13th postoperative day, a cardiac arrest in asystole occurred, with no response to the undertaken resuscitation procedures. An autopsy performed in the Department of Forensic Medicine in Łódź revealed, among other findings, acute pancreatitis with enzymatic necrosis of the adipose tissue, a significant accumulation of lymph in both pleural cavities, and pulmonary atelectasis. As demonstrated by the analysis of the case, chylothorax had most probably developed in the course of acute pancreatitis which was a complication of the cesarean section. Consequently, the prosecutor opened an investigation into the case under Article 155 of the Polish Penal Code to assess the appropriateness of medical management. The medico-legal opinion was issued by experts from outside the Department of Forensic Medicine in Łódź. In their view, the medical management of the patient was correct.

  3. Surveillance of surgical site infection after cesarean section and time of notification.

    Science.gov (United States)

    Lima, Júnia Leonne Dourado de Almeida; de Aguiar, Regina Amélia Lopes Pessoa; Leite, Henrique Vitor; Silva, Hercules Hermes Riani Martins; de Oliveira, Werlley Meira; Sacramento, João Paulo Tomaz da Cunha; Wakabayashi, Eduarda Almeida; de Souza, Helen Cristina; Clemente, Wanessa Trindade; Romanelli, Roberta Maia de Castro

    2016-03-01

    Cesarean section is a surgical procedure the main complication of which is surgical site infection (SSI), which is related to maternal morbidity and mortality. To evaluate active monitoring by telephone to identify infection and time of SSI report in postpartum women and associated risk factors. We conducted a prospective observational study from 2013-2014, at a referral service for high-risk pregnancies. Surveillance was conducted via telephone at least 30 days after cesarean delivery. Incidence ratio and time of infection occurrence (days) was analyzed. Survival analysis was conducted to assess the temporal distribution of the development of infection. Of a total of 353 patients, 14 (4%) cases of SSI were reported, and 10 (7.4%) of the reported cases occurred within 15 days after cesarean and average time of infection was12.21 days. American Society of Anesthesiologists score was the only risk factor associated with SSI after cesarean section. The prevalence of SSI after cesarean section via telephone is similar to several services with different methods of surveillance, considering it could be used by services with limited resources. Superficial incisional SSI was the most common type of infection, time of infection report was mainly before the 15th day postprocedure, and American Society of Anesthesiologists score of 2 or less was protective against SSI. Telephone calls can be a viable method to identify women with infection briefly after discharge, particularly at-risk patients. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  4. [Variation of prevalence of macrosomia and cesarean section and its influencing factors].

    Science.gov (United States)

    Wei, Yumei; Yang, Huixia

    2015-03-01

    To investigate the varaiation of the incidence of macrosomia and its influencing factors. A population-based study of 25 944 pregnant women, who delivered in Peking University First Hospital in term birth, with singleton, between Jan. 1, 2006 and Dec. 31, 2013 and accepted the gestational diabetes mellitus (GDM) screening and diagnosis, was performed. The women are grouped according to the different clinical interventions at different period. Women delivered between Jan.1, 2006 and Dec. 31, 2006 was defined as Group 2006, and they were diagnosed with glucose metabolism disorder [gestational impaired glucose tolerance (GIGT) and GDM] and intervened only when meeting National diabetes data group (NDDG) criteria. Women delivered between Jan. 1, 2007 and Apr. 30, 2011 were defined as Group post 2007, and NDDG criteria was also applied in this period. Women delivered between May. 1, 2011 and Dec. 31, 2013 were defined as Group post 2011, and Ministry of Health (MOH) of China was used for GDM diagnosis in this group. All pregnant women in Group post 2007 accepted the preliminary pregnancy nutrition advice and weight management. All participants met MOH criteria were diagnosed as glucose metabolism disorder in this study, in which women diagnosed and intervened in pregnancy were defined as Group diagnosis and those not being identified during pregnancy were defined as Group missed diagnosis. It was analyzed retrospectively for the incidence of macrosomia and the influencing factor. (1) The prevalence of macrosomia and cesarean section was decreased every year from Jan. 2006 to Dec. 2013. The incidence of macrosomia was 9.14% in 2006, reduced to 8.02% in 2007-2011 and 6.79% in 2011-2013. The incidence of cesarean section was 55.22%, reduced to 51.04% in 2007-2011 and 44.15% in 2011-2013. However, there was not remarkable change in the prevalence of small for gestational age (P > 0.05). (2) Compared with Group 2006, the incidence of cesarean section was lower in Group post

  5. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section.

    Science.gov (United States)

    Smaill, Fiona M; Grivell, Rosalie M

    2014-10-28

    The single most important risk factor for postpartum maternal infection is cesarean section. Although guidelines endorse the use of prophylactic antibiotics for women undergoing cesarean section, there is not uniform implementation of this recommendation. This is an update of a Cochrane review first published in 1995 and last updated in 2010. To assess the effects of prophylactic antibiotics compared with no prophylactic antibiotics on infectious complications in women undergoing cesarean section. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2014) and reference lists of retrieved papers. Randomized controlled trials (RCTs) and quasi-RCTs comparing the effects of prophylactic antibiotics versus no treatment in women undergoing cesarean section. Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. The clinically important primary outcomes were wound infection, endometritis, serious maternal infectious complications and adverse effects on the infant. We presented dichotomous data as risk ratios (RR), with 95% confidence intervals (CIs) and combined trials in meta-analyses. We assessed the quality of evidence using the GRADE approach. We identified 95 studies enrolling over 15,000 women. Compared with placebo or no treatment, the use of prophylactic antibiotics in women undergoing cesarean section reduced the incidence of wound infection (RR 0.40, 95% CI 0.35 to 0.46, 82 studies, 14,407 women), endometritis (RR 0.38, 95% CI 0.34 to 0.42, 83 studies, 13,548 women) and maternal serious infectious complications (RR 0.31, 95% CI 0.20 to 0.49, 32 studies, 6159 women). When only studies that included women undergoing an elective cesarean section were analyzed, there was also a reduction in the incidence of wound infections (RR 0.62, 95% CI 0.47 to 0.82, 17 studies, 3537 women) and endometritis (RR 0.38, 95% CI 0.24 to 0.61, 15 studies, 2502 women) with prophylactic

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

    Science.gov (United States)

    Benevides, Márcio Luiz; Brandão, Verônica Cristina Moraes; Lovera, Jacqueline Ivonne Arenas

    2016-01-01

    The increased prevalence of obesity in the general population extends to women of reproductive age. The aim of this study is to report the perioperative management of a morbidly obese pregnant woman, body mass index > 50 kg/m(2), who underwent cesarean section under general anesthesia. Pregnant woman in labor, 35 years of age, body mass index 59.8 kg/m(2). Caesarean section was indicated due to the presumed fetal macrosomia. The patient refused spinal anesthesia. She was placed in the ramp position with cushions from back to head to facilitate tracheal intubation. Another cushion was placed on top of the right gluteus to create an angle of approximately 15° to the operating table. Immediately before induction of anesthesia, asepsis was carried out and sterile surgical fields were placed. Anesthesia was induced in rapid sequence, with Sellick maneuver and administration of remifentanil, propofol, and succinilcolina. Intubation was performed using a gum elastic bougie, and anesthesia was maintained with sevoflurane and remifentanil. The interval between skin incision and fetal extraction was 21 minutes, with the use of a Simpson's forceps scoop to assist in the extraction. The patient gave birth to a newborn weighing 4850 g, with Apgar scores of 2 in the 1(st) minute (received positive pressure ventilation by mask for about 2 minutes) and 8 in the 5(th) minute. The patient was extubated uneventfully. Multimodal analgesia and prophylaxis of nausea and vomiting was performed. Mother and newborn were discharged on the 4(th) postoperative day. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  7. Intra-operative maternal complications of emergency cesarean section done in advanced labor

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    Nisa, M.U.

    2013-01-01

    Background: Emergency cesarean section done in advanced labor is a big challenge in obstetrics due to increased risk of intraoperative complications. In the last decade, a rapid increase in cesarean section done in advanced labor has been observed. Difficult deli-very of the fetal head during cesarean section carries a high risk of intraoperative complications like cervical and uterine tears, intra operative hemorrhage and trauma to the baby. Objectives: The purpose of this study is to find out the frequency and risk factors for intra-operative complications in emergency cesarean section done in advanced labor, so that appropriate management protocols can be planned to reduce these complications. Study Design: Prospective cohort study. Materials and Methods: This prospective study was carried out in Obstetrics and Gynecology Unit - 2 of Services Institute of Medical Sciences, Services Hospital, Lahore; from 1st January 2007 to 31st December 2007. All patients undergoing emergency cesarean sections done on laboring mothers were included in the study. The sample was divided into two groups; emergency C-section done in advanced labor as the study group and emergency C-section in early labor as the control group. Data were collected regarding age, parity, booked or unbooked status, indications for cesarean section, level of competence of operating surgeon, intra-operative complications and the risk factors for these complications. Data were recorded on a structured proforma and compared between the two groups. Statistical Analysis: Data were analyzed using computer programme SPSS Version 14 for windows applying student t-test for quantitative and chai square test for qualitative parameters. A p-value < 0.05 was used as statistically significant. Results: Out of 2064 total deliveries in the year 2007, 1290 (62.5%) were vaginal deliveries and 774 (37.5%) were C-Sections. Out of 774 C-Section, 174 (23%) were elective and 600 (77%) were emergency. Out of 600 emergency C-sections

  8. Cesarean section and the risk of emergency peripartum hysterectomy in high-income countries: a systematic review.

    Science.gov (United States)

    de la Cruz, Cara Z; Thompson, Erika L; O'Rourke, Kathleen; Nembhard, Wendy N

    2015-12-01

    Our objective was to determine the incidence and mortality rates associated with emergency peripartum hysterectomy, factors that lead to uncontrolled hemorrhage and emergency peripartum hysterectomy, and to determine the relationship between cesarean section and risk of emergency peripartum hysterectomy. Studies published between January 1, 2000 and December 31, 2012 were identified using PubMed, OVID and Web of Science databases. Studies were included if they reported incidence rates for emergency peripartum hysterectomy, factors that lead to hemorrhage and emergency peripartum hysterectomy, or the association of emergency peripartum hysterectomy with cesarean section in high-income countries. Four hundred and fifty-one studies were identified, and 52 were included. The incidence of emergency peripartum hysterectomy ranged from 0.20 to 5.09 per 1000 deliveries with a median incidence rate of 0.61 per 1000 deliveries. These rates have increased over time. Rates varied by region/country, specifically with the United States reporting higher rates than North American, Asian, Oceania, and European countries. The most common factor leading to emergency peripartum hysterectomy was placental abnormalities. Both cesarean section and prior cesarean section were strong risk factors for emergency peripartum hysterectomy with higher risks conferred for each additional cesarean section. The mean percentage of maternal deaths for EPH survivors was 3.0 %. Given the association of cesarean section with emergency peripartum hysterectomy, the increased risk of emergency peripartum hysterectomy should be factored into the decision of whether to proceed with cesarean delivery, particularly for women who desire more children.

  9. A systematic review of the effectiveness of warming interventions for women undergoing cesarean section.

    Science.gov (United States)

    Munday, Judy; Hines, Sonia; Wallace, Karen; Chang, Anne M; Gibbons, Kristen; Yates, Patsy

    2014-12-01

    Women undergoing cesarean section are vulnerable to adverse effects associated with inadvertent perioperative hypothermia, but there has been a lack of synthesized evidence for temperature management in this population. This systematic review aimed to synthesize the best available evidence in relation to preventing hypothermia in mothers undergoing cesarean section surgery. Randomized controlled trials meeting the inclusion criteria (adult patients of any ethnic background, with or without comorbidities, undergoing any mode of anesthesia for any type of cesarean section) were eligible for consideration. Active or passive warming interventions versus usual care or placebo, aiming to limit or manage core heat loss in women undergoing cesarean section were considered. The primary outcome was maternal core temperature. A comprehensive search with no language restrictions was undertaken of multiple databases from their inception until May 2012. Two independent reviewers using the standardized critical appraisal instrument for randomized controlled trials from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instruments (JBI-MASTARI) assessed retrieved papers for methodological quality and conducted data collection. Where possible, results were combined in a fixed effects meta-analysis using the Cochrane Collaboration Review Manager software. Due to heterogeneity for one outcome, random effects meta-analysis was also used. A combined total of 719 participants from 12 studies were included. Intravenous fluid warming was found to be effective at maintaining maternal temperature and preventing shivering. Warming devices, including forced air warming and under-body carbon polymer mattresses, were effective at preventing hypothermia. However, effectiveness increased if the devices were applied preoperatively. Preoperative warming devices reduced shivering and improved neonatal temperatures at birth. Intravenous fluid warming did not improve

  10. Concomitant Vesicouterine Rupture with Avulsion of Ureter: A Rare Complication of Vaginal Birth after Cesarean Section.

    Science.gov (United States)

    Sharma, Nalini; Thiek, J Lalnunnem; Sialo, Stephen; Ahanthem, Santa Singh

    2016-03-01

    Uterine rupture is the most serious and life threatening complication and occurs in 0.7-0.9% of vaginal birth after lower segment caesarean section. Cases of bladder rupture along with uterine rupture have been rarely reported and avulsion of ureter, required ureteric implantation is even rarer. This case report describe a very rare case of vesicouterine rupture with avulsion of ureter following vacuum assisted delivery in a grandmulti with previous lower segment cesarean section (LSCS). Haematuria is the most common presentation of bladder rupture. Antenatal counseling regarding this entity is recommended if woman opted for vaginal birth after cesarean section. Intrapartum and postpartum high index of suspicion are important in clinching the diagnosis.

  11. [Postoperative surveillance of wound infection after cesarean section at Kenézy Hospital, Debrecen, Hungary].

    Science.gov (United States)

    Várkonyi, István; Makai, Ildikó; Papdiné Nyíri, Gyöngyi; Bacskó, György; Kardos, László

    2011-01-02

    Wound infection is a typical, partly preventable complication of cesarean sections. We started extended recording of cesarean section data in October, 2008 as part of our general wound infection surveillance program. To describe the circumstances and outcomes of the sections and analyze associations between them. We analyzed 523 cases over the period October 1, 2008 to September 30, 2009. Variables were assessed using descriptive statistics. Associations between explanatory factors and wound infection were evaluated using logistic regression. Infections (overall rate: 3.6%) were more frequent in younger subjects, those with anemia, subcutaneous hematoma, in pregnancies with meconium stained or purulent amniotic fluid, and decreased to about a third after infection control was tightened. by being a proxy variable of factors with which wound infection is associated, age is a clinically valuable predictive variable. Good infection control practice is effective in preventing wound infections. The results are consistent with appropriate prescription practices of prophylactic antibiotic use, and with prophylactic measures being effective.

  12. Cervical ripening with Foley catheter for induction of labor after cesarean section: a cohort study.

    Science.gov (United States)

    Jozwiak, Marta; van de Lest, Hilde A; Burger, Nicole B; Dijksterhuis, Marja G K; De Leeuw, Jan Willem

    2014-03-01

    To evaluate spontaneous vaginal delivery and complication rates after induction of labor with a transcervical Foley catheter in women with a previous cesarean delivery. Retrospective cohort study. Secondary teaching hospital in the second largest city of the Netherlands. Women with a history of cesarean delivery (n = 208), undergoing induction of labor with a Foley catheter in a subsequent pregnancy. The women who had induction of labor with a transcervical Foley catheter in the Ikazia Hospital, Rotterdam, between January 2003 and January 2012, were identified in a computerized database. Patient's records were checked for accuracy. Vaginal delivery rate, cesarean section rate, uterine rupture and maternal and neonatal (infectious) morbidity. Of the women 60% had a spontaneous vaginal delivery and 11% were delivered by vacuum extraction. Uterine rupture occurred in one woman. Postpartum hemorrhage was the most common maternal complication (12%). Maternal intrapartum and postpartum infections occurred in 5% and 1%. Proven neonatal infection was found in 3% of the cases. Two perinatal deaths occurred (1%), of which one was related to uterine rupture. Induction of labor with a transcervical Foley catheter is an effective method to achieve vaginal delivery in women with a previous cesarean delivery. There is a low risk of uterine rupture and maternal and neonatal (infectious) morbidity in this cohort. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

  13. Cesarean section indications and anthropometric parameters in Rwandan nulliparae: preliminary results from a longitudinal survey.

    Science.gov (United States)

    Kakoma, Jean-Baptiste

    2016-01-01

    Maternal anthropometric parameters as risk factors for cesarean section have always been a matter of interest and concern for obstetricians. Some of these parameters have been shown to be predictors of dystocia. This study aims at showing the relationship between cesarean section indications and anthropometric parameters sizes in Rwandan nulliparae for the purpose of comparison and appropriate recommendations. A cross-sectional and analytical study was made on data collected from 32 operated patients among 152 nulliparae with singleton pregnancy at term and vertex presentation. Concerned anthropometric parameters were height, weight and six pelvic distances. Fisher exact and Student's tests were used to compare observed proportions and mean values, respectively. Findings were as follows: 1) the overall cesarean section rate was 21.05%; 2) acute fetal distress (31.3 %), generally contracted pelvis (28.1 %), and engagement failure (25%) were the most frequent indications of cesarean section; 3) all patients ≤ 145 cm tall were operated on for general pelvis contraction whose proportion was significantly higher in them than in the others (p < 0.01); 4) more than half of pelvis contraction cases were observed in patients weighing ≤ 50 kg, but the difference with other weight categories was not significant; 5) considered external pelvic diameters but the Biiliac Diameter displayed average measurements smaller in clinically contracted pelvis than in other CS indications. External pelvimetry associated with specific other anthropometric parameters could be helpful in the screening of generally contracted pelves, and consequently pregnancies at high risk of cephalopelvic disproportion in nulliparous women, particularly in developing countries with limited resources. Further investigations are requested to deal with this topic in depth.

  14. Maternal complications in settings where two-thirds of extremely preterm births are delivered by cesarean section.

    Science.gov (United States)

    Hesselman, Susanne; Jonsson, Maria; Råssjö, Eva-Britta; Windling, Monika; Högberg, Ulf

    2017-01-01

    To investigate the maternal complications associated with cesarean section (CS) in the extremely preterm period according to the gestational week (GW) and to indication of delivery. This is a retrospective case-referent study with a review of medical records of women who delivered at 22-27 weeks of gestation (n=647) at two level III units in Sweden. For abdominal delivery, gestational length was stratified into 22-24 (n=105) and 25-27 (n=301) weeks. For comparison, data on women who underwent a CS at term were identified in a register-based database. The rate of CS in extremely preterm births was 62.8%. There was no difference in the complication rates, but types of incisions other than the low transverse incision were required more often at 22-24 (18.1%) weeks than at 25-27 GWs (9.6%) (P=0.02). Major maternal complications occurred in 6.6% compared with 2.1% in the extremely preterm and term CS, respectively (Pcomplications. Almost two-thirds of the births at 22-27 GWs had an abdominal delivery. No increase in short-term morbidity was observed at 22-24 weeks compared to 25-27 weeks. CS performed extremely preterm had more major complications recorded than cesarean at term. The complications are driven by the underlying maternal condition.

  15. Cesarean Section Rate Analysis in University Hospital Tuzla - According to Robson's Classification.

    Science.gov (United States)

    Fatusic, Jasenko; Hudic, Igor; Fatusic, Zlatan; Zildzic-Moralic, Aida; Zivkovic, Milorad

    2016-06-01

    For last decades, there has public concern about increasing Cesarean Section (CS) rates, and it is an issue of international public health concern. According to World Health Organisation (WHO) there is no justification to have more than 10-15% CS births. WHO proposes the Robson ten-group classification, as a global standard for assessing, monitoring and comparing cesarean section rates. The aim of this study was to investigate Cesarean section rate at University Hospital Tuzla, Bosnia and Herzegovina. Cross sectional study was conducted for one-year period, 2015. Statistical analysis and graph-table presentation was performed using Excel 2010 and Microsoft Office programs. Out of 3,672 births, a total of 936 births were performed by CS. Percentage of the total number of CS to the total birth number was 25,47%. According to Robson classification, the largest was group 5 with relative contribution of 29,80%. On second and third place were group 1 and 2 with relative contribution of 26,06% and 15,78% respectively. Groups 1, 2, 5 made account of realtive contribution of 71,65%. All other groups had entirely relative contribution of 28,35%. Robson 10-group classification provides easy way in collecting information about CS rate. It is important that efforts to reduce the overall CS rate should focus on reducing the primary CS. Data from our study confirm this attitude.

  16. Effect of Acupressure on Symptoms of Postoperative Ileus After Cesarean Section.

    Science.gov (United States)

    Abadi, Faezeh; Shahabinejad, Maryam; Abadi, Foziyeh; Kazemi, Majid

    2017-04-01

    Postoperative ileus (POI) is a common complication after most abdominal surgeries including cesarean section. It is associated with longer hospitalization and increased medical costs. This study is a randomized controlled trial investigating the effect of acupressure, and low-cost noninvasive traditional treatment, on POI symptoms after cesarean section. A total of 120 patients were randomly divided into two groups; the treatment group received two sessions of acupressure (an hour after attending the women's division; and 3 hours after the first session), each lasting 20 minutes. The time of flatus and defecation, time to presence of bowel sounds, and duration of postoperative bed rest were monitored. Patients in the treatment group had a shorter time to presence of bowel sounds compared with those in the control group (pcesarean section, and can be used as a low-cost noninvasive nursing care to reduce POI incidence and intensity after cesarean section. Copyright © 2017 Medical Association of Pharmacopuncture Institute. Published by Elsevier B.V. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Kumi Moriyama

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

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

    Science.gov (United States)

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

    2016-09-01

    A 39-year-old woman underwent emergency cesarean section (CS) due to placenta previa totalis with massive bleeding. Two major problems emerged in this patient after CS was carried out. One was partial retention of the placenta due to placenta accreta. Another major and more serious problem was pyoderma gangrenosum (PG) widely appearing at the skin of the abdomen around the CS wound. Conservative treatment was performed for the retained placenta, and it had completely disappeared by 76 days after the CS. The diagnosis of PG was promptly made in consultation with a plastic surgeon and a dermatologist when a wide ulcer emerged around the CS wound, and high-dose prednisolone was administered as treatment. At 90 days following the CS, near-complete epithelialization was achieved. This extremely rare case reflects the importance of rapid diagnosis and treatment of PG. © 2016 Japan Society of Obstetrics and Gynecology.

  19. Cimethidine pre-anesthetic. A prophylactic method against Mendelson's syndrome in cesarean section

    DEFF Research Database (Denmark)

    Qvist, N; Storm, K

    1983-01-01

    Twenty patients undergoing cesarean section received cimethidine 400 mg intramuscularly as pre-anesthetic approximately 70 minutes prior to gastric aspiration. The average pH was 5.05, as against 2.97 in the control group (p less than 0.01). No significant reduction in the aspirated volumes was o...... in the infants. Hence, cimethidine is a safe and useful pre-anesthetic for patients undergoing cesarean section, irrespective of indication and, consequently, much to be preferred to oral antacids....... was observed. In the cimethidine group the proportion of patients at risk of developing Mendelson's syndrome (pH less than 2.5 and volume greater than 25 ml) was significantly reduced, viz. 5% as against 42% in the control group (P = 0.014). No perinatal effects attributable to cimethidine was observed...

  20. Cesarean section after abdominal mesh repair for pregnancy-related desmoid tumor: a case report

    Directory of Open Access Journals (Sweden)

    Ooi S

    2017-07-01

    Full Text Available Sara Ooi, Harry Ngo Obstetrics and Gynaecology Department, Liverpool Hospital, Liverpool, NSW, Australia Abstract: We report the case of a 32-year-old gravida 2 para 1 woman with a background of partially resected desmoid tumor (DT arising from the previous cesarean section (CS scar. This case details the management of her DT by surgical resection and mesh repair and second pregnancy following this. Pregnancy-related DTs are a relatively rare entity, and there is a paucity of literature regarding their management during pregnancy. There are only five reported cases of DTs arising from CS scars. To our knowledge, this is the only report to illustrate that subsequent CS is possible after desmoid resection and abdominal mesh repair. It provides evidence that CS can be safely accomplished following abdominal wall reconstructions and further arguments against elective lower segment CS. Keywords: abdominal wall, cesarean section, complications, desmoid tumor, surgical mesh

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

    Directory of Open Access Journals (Sweden)

    Maryam Ravanipour

    2004-09-01

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

  2. Flash pulmonary edema during cesarean section in a woman with preeclampsia.

    Science.gov (United States)

    Euser, Anna G; Wiegman, Marjon J; Cantineau, Astrid E P; Zeeman, Gerda G

    2012-10-01

    Pulmonary edema may complicate preeclampsia. We report intraoperative flash pulmonary edema in a preeclamptic woman with Rendu-Osler-Weber syndrome. The patient was admitted at 33(+6) weeks gestation with preeclampsia. After rapid sequence induction and endotracheal intubation for cesarean section, flash pulmonary edema developed without evidence of cardiac dysfunction. She was mechanically ventilated and treated with furosemide. Following brisk diuresis she was extubated the next day and discharged on postoperative day 9 in good clinical condition. Endotracheal intubation for general anesthesia can cause acutely increased blood pressure, which, with concomitant low oncotic pressure, we believe contributed to intraoperative flash pulmonary edema. We present this case to raise awareness of this complication when general anesthesia is used for cesarean section in preeclampsia. Copyright © 2012. Published by Elsevier B.V.

  3. Effect of perioperative fetal intrauterine hypoxia on maternal oxidative stress injury after cesarean section

    Directory of Open Access Journals (Sweden)

    Xue-Hong Zou

    2017-03-01

    Full Text Available Objective: To study the effect of perioperative fetal intrauterine hypoxia on maternal oxidative stress injury after cesarean section. Methods: 37 puerperae receiving cesarean section for fetal intrauterine hypoxia between May 2014 and December 2016 were selected as hypoxia group and 40 puerperae receiving cesarean section during the same period and without complications during pregnancy or fetal intrauterine hypoxia were selected as control group. Umbilical arterial blood was collected after delivery of placenta for blood gas analysis, and the placenta tissue and serum samples were collected to test the content of oxidative stress products and antioxidants. Results: Umbilical arterial blood gas analysis parameters pH value as well as PO2, HCO3 - and BE content of hypoxia group were significantly lower than those of control group (P<0.05; NADPH, reactive oxide species (ROS and reactive nitrogen species (RNS content in placenta tissue of hypoxia group were significantly higher than those of control group (P <0.05 while glutathione S-transferase (GST, glutathione peroxidase (GPx, superoxide dismutase (SOD, Trx, vitamin C (VitC, VitE and coenzyme Q10 (CoQ10 content were significantly lower than those of control group (P<0.05; serum malondialdehyde (MDA and 8-iso-prostaglandin F2α (8-iso-PGF2α content of hypoxia group were significantly higher than those of control group (P<0.05. Conclusions: Perioperative fetal intrauterine hypoxia can lead to maternal oxidative stress injury after cesarean section and increase the generation of free radicals and the consumption of antioxidants.

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

    Science.gov (United States)

    Anson, Jonathan A; McQuillan, Patrick M

    2014-01-01

    A healthy 21-year-old primigravida presented for elective cesarean section. At 45 min after intrathecal (IT) injection of bupivacaine, morphine and fentanyl she developed dysphagia, right sided facial droop, ptosis and ulnar nerve weakness. This constellation of signs and symptoms resolved 2 h later. Based on the time course and laterality of her symptoms, as well as the pharmacologic properties of spinal opioids, we believe her symptoms can be attributed to the IT administration of fentanyl. PMID:24803773

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

    Directory of Open Access Journals (Sweden)

    Jonathan A Anson

    2014-01-01

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

  6. Comparison of moxalactam and cefazolin as prophylactic antibiotics during cesarean section.

    OpenAIRE

    Rayburn, W; Varner, M; Galask, R; Petzold, C R; Piehl, E

    1985-01-01

    Prophylactic antibiotics have been shown to be effective in decreasing the incidence of febrile morbidity associated with cesarean section after labor. However, the relative effectiveness of different single antibiotics has been studied infrequently, and these investigations have been limited by small patient samples. Several new, broad-spectrum antibiotics are now available, and any further benefit from more traditional antibiotics for surgical prophylaxis remains untested. A randomized pros...

  7. Cesarean section and right femur fracture: a rare but possible complication for breech presentation

    OpenAIRE

    Capobianco, Giampiero; Virdis, Giuseppe; Lisai, Pietro; Cherchi, Claudio; Biasetti, Ornella; Dessole, Francesco; Meloni, Giovanni Battista

    2013-01-01

    Background. The breech extraction of the fetus through the vagina has a greater risk of hip fracture compared with the extraction by abdominal route. Case. A 2390 g female infant was delivered at 39 weeks by elective cesarean section for breech presentation. The newborn sustained a fracture of the right femur. A simple immobilization of the limb in extension led to a complete healing of the fracture without sequelae. Conclusion. Caesarean delivery reduces the risk of causing a traumatic injur...

  8. Vasopressor choice for hypotension in elective Cesarean section: ephedrine or phenylephrine?

    Science.gov (United States)

    Gunda, Chandrakala P; Malinowski, Jennifer; Tegginmath, Aruna; Suryanarayana, Venkatesh G; Chandra, Sathees B C

    2010-04-30

    Hypotensive episodes are a common complication of spinal anesthesia during Cesarean section. The purpose of this study was to compare the effectiveness and the side effects of vasopressors, ephedrine and phenylephrine, administered for hypotension during elective Cesarean section under spinal anesthesia. The study consisted of 100 selected ASA I/II females scheduled for elective Cesarean section under spinal anesthesia. Each patient was randomly assigned to one of the two double-blind study groups. Group E received 1 ml ephedrine (5 mg/ml) with normal saline if hypotension was present (n=50). Group P received 1 ml phenylephrine (100 µg/ml) with normal saline if hypotension developed (n=50). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) were compared within and between groups to basal levels at time increments of 0, 2, 4, 6, 8, 10, 15, 20, 25, 30, 45, and 60 min from start of surgery. Incidence of side effects and neonatal outcomes were studied between groups. All patients required vasopressor therapy for hypotension. Administration of phenylephrine was associated with significant drop in HR. Changes in SBP, DBP, and MAP were similar in both groups for most observed times. The incidences of nausea/vomiting and tachycardia were significantly higher in the ephedrine group. Phenylephrine and ephedrine are acceptable choices to combat maternal hypotension related to spinal anesthesia in elective Cesarean section. Complications of intra-operative nausea and vomiting, tachycardia and bradycardia should be considered when choosing a vasopressor, suggesting phenylephrine may be more appropriate when considering maternal well-being.

  9. Maternal complications and cesarean section without indication: systematic review and meta-analysis

    Science.gov (United States)

    Mascarello, Keila Cristina; Horta, Bernardo Lessa; Silveira, Mariângela Freitas

    2017-01-01

    ABSTRACT OBJECTIVE The objective of this study was to determine the risks of severe acute maternal complications associated with cesarean section without medical indication. METHODS A systematic review was carried out with meta-analysis. The literature search was performed systematically, in multiple stages, in the PubMed, Lilacs, and Web of Science databases using the following descriptors: (postpartum period) and (cesarean section or natural childbirth) and ((morbidity or mortality) or (postpartum hemorrhage) or (puerperal infection) or (surgical infection) or (puerperal disorders)). The protocol of the study was registered at PROSPERO as CRD42016032933. A total of 1,328 articles were found; after selection, eight publications that met the study objective and inclusion criteria were selected, with information on 1,051,543 individuals. RESULTS The results obtained in the meta-analyses indicate that women with cesarean section have a higher chance of maternal death (OR = 3.10, 95%CI 1.92–5.00) and postpartum infection (OR = 2.83, 95%CI, 1.585.06), but they have a lower chance of hemorrhage (OR = 0.52, 95%CI 0.48–0.57). For the blood transfusion outcome, the group effect was not associated with the type of delivery (95%CI 0.88–2.81). CONCLUSIONS The quality of evidence was considered low for hemorrhage and blood transfusion and moderate for postpartum infection and maternal death. Thus, cesarean sections should be performed with caution and safety, especially when its benefits outweigh the risks of a surgical procedure. PMID:29166440

  10. Rare Cryptococus gattii infection in an immunocompetent dairy goat following a cesarean section

    OpenAIRE

    Villarroel, Aurora; Maggiulli, Tessa R.

    2012-01-01

    A 5-year-old dairy goat was presented seven weeks post cesarean section for incomplete healing of the incision site. Cytology revealed cryptococcal organisms that were confirmed by the Centers for Disease Control as Cryptococcus gattii type VGIIa. Most cryptococcomas were surgically removed, but some penetrated deep in to the muscular layers and likely into peritoneum. The goat was treated daily with oral fluconazole for 6 months, and had a normal life for almost 2 years.

  11. Dexmedetomidine improves intraoperative conditions and quality of postoperative analgesia when added to epidural in elective cesarean section

    Directory of Open Access Journals (Sweden)

    Samy Elsayed Hanoura

    2014-10-01

    Conclusion: Adding dexmedetomidine to regular mixture of epidural anesthetics in women undergoing elective cesarean section improved intraoperative conditions and quality of postoperative analgesia without maternal or neonatal significant side effects.

  12. 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)

  13. Minidose Bupivacaine – Fentanyl Spinal Anesthesia for Cesarean Section In Preeclamptic Parturients

    Directory of Open Access Journals (Sweden)

    N. Fatholahzadeh

    2006-07-01

    Full Text Available Background:Spinal anesthesia for cesarean section is associated with a high incidence of hypotension. The synergism between intrathecal opioids and local anesthetics may make it possible to achieve reliable spinal anesthesia with minimal hypotension using a minidose of local anesthetic. Methods: Forty-four preeclamptic parturients undergoing cesarean section were randomized in two groups of 22 patients. Group A received a spinal anesthetic of bupivacaine 6 mg plus fentanyl 20 µg , and group B received 12 mg bupivacaine. Hypotension was defined as a 30% decrease in systolic and diastolic pressure from baseline. Hypotension was treated with intravenous ephedrine boluses 2.5-5 mg up to maximum 50 mg. Results: All patients had satisfactory anesthesia. Five of 22 patients in group A required ephedrine, a single dose of 5 mg. Seventeen of 22 patients in group B required vasopressor support of blood pressure.The lowest recorded systolic,diastolic and mean blood pressures as fractions of the baseline pressures were 71.2%, 64.5% and 70.3% versus 59.9%, 53.5% and 60.2% respectively for group A versus group B. Conclusion: A “minidose” of 6 mg bupivacaine in combination with 20 µg fentanyl may provide satisfactory spinal anesthesia for cesarean section in the preeclamptic patient. The minidose combination caused dramatically less hypotension than 12 mg bupivacaine and nearly eliminated the need for vasopressor support of blood pressure. 

  14. A Comparison of Satisfaction; Spinal versus General Anesthesia for Cesarean Section

    International Nuclear Information System (INIS)

    Meo, S. A.; Siddique, S.; Meo, R. A.

    2013-01-01

    Objective: To compare the patients satisfaction with spinal and general anesthesia after cesarean section at CMH Lahore. Study Design: Randomized controlled trials. Study Setting: The study was conducted at the department of Obstetrics and Gynaecology combined military Hospital, Lahore, for 6 months from July to Dec 2011. Patients and Methods: Total 70 patients were included in the study and randomly divided into two groups of 35 each using random numbers table. All patients between ages of 20-40 years admitted for elective cesarean section and presented for following up at day 5-7 who never had any type of anesthesia in the past. There included in the study patients with complaints of migraine, low backaches, positive history or any other medical disorder were excluded from the study. Results: A total number of patients included were 70. Out of these selected patients, 35 procedures were carried out under spinal anesthesia and 35 under general anesthesia. Insignificant difference was found in satisfaction level of both the groups (p=0.220). There is significant difference for the future choice between two groups (p<0.001). Conclusion: Spinal anesthesia provides equal satisfaction for patients of cesarean section than general anesthesia. (author)

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

    Directory of Open Access Journals (Sweden)

    Fereshteh Naziri

    2013-09-01

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

  16. Impact of pharmacist interventions on rational prophylactic antibiotic use and cost saving in elective cesarean section.

    Science.gov (United States)

    Wang, Jingwen; Dong, Mohan; Lu, Yang; Zhao, Xian; Li, Xin; Wen, Aidong

    2015-08-01

    To assess the impact of pharmacist interventions on rational use of prophylactic antibiotics and cost saving in elective cesarean section and the economic outcomes of implementing pharmacist interventions. A pre-to-post intervention design was applied to the practices of prophylactic antibiotic use in the department of gynecology and obstetrics in a Chinese tertiary hospital. Patients admitted during a 3-month period from June to August 2012 and during that from October to December 2012 undergoing elective cesarean section were assigned to the pre-intervention and the post-intervention group, respectively. Pharmacist interventions were performed in the post-intervention group, including obstetrician education, realtime monitoring of clinical records and making recommendations to obstetricians on prophylactic antibiotic prescription based on the criteria set at the beginning of the study. Data from the two groups were then compared to evaluate the outcomes of pharmacist interventions. Cost-outcome analysis was performed to determine the economic effect of implementing pharmacist interventions in preoperative antibiotic prophylaxis. Pharmacist interventions led to significant reductions in antibiotic usage cost/patient-day (p antibiotic cost (p antibiotics (p antibiotic use to the cost of pharmacist time was 27.23 : 1 and the net cost benefit was $65,255.84. This study provides evidence that pharmacist interventions promoted rational use of prophylactic antibiotics and substantial cost saving in elective cesarean section.

  17. The application of uterine artery chemoembolization in treating cesarean section scar pregnancy

    International Nuclear Information System (INIS)

    Zhang Guofu; Wang Tianping; Gu Shouxin; Han Zhigang; Zhang Di; Tian Xiaomei; Wang Xuezhen; Yu Fei; Huang Zirong

    2010-01-01

    Objective: To discuss the feasibility and safety of uterine artery chemoembolization in treating cesarean section scar pregnancy. Methods: During the period of Jun. 2005-Jun. 2010, uterine artery chemoembolization was performed in 130 patients with cesarean section scar pregnancy in authors' hospital. Via bilateral uterine arteries 100-150 mg MTX and 80 000 u Gentamycin were infused separately, which was followed by the embolization of bilateral uterine arteries with Gelfoam. Of the total 130 patients,coexisted leiomyoma was found in 23 and embolization therapy with PVA microspheres was employed. Curettage of uterus was carried out within 24-72 hours after the procedure. Results: The success rate of bilateral uterine artery chemoembolization was 100%. The blood loss during curettage procedure was 12-110 ml (mean 28.5 ml). No serious complications occurred. Conclusion: The uterine artery chemoembolization is an effective and safe treatment for cesarean section scar pregnancy. This technique can greatly avoid unnecessary uterectomy and, thus, preserve the fertility of the female patients. (authors)

  18. Women's antenatal preferences for delivery route in a setting with high cesarean section rates and a medically dominated maternity system.

    Science.gov (United States)

    Dweik, Diána; Girasek, Edmond; Töreki, Annamária; Mészáros, Gyula; Pál, Attila

    2014-04-01

    To assess birth preferences in a sample of Hungarian pregnant women and identify determinants of ambivalence or clear choices for cesarean section throughout pregnancy. Follow-up two-point questionnaire survey. University Department of Obstetrics and Gynecology in Hungary. A total of 413 women with singleton pregnancies where there was no awareness of medical contradictions to vaginal delivery, attending for routine ultrasound examination in mid-pregnancy from November 2011 to March 2012. Questionnaires completed in mid- and late pregnancy (gestational weeks 18-22 and 35-37) including the Wijma Delivery Expectancy/Experience Questionnaire A. Prevalence of women preferring cesarean section or being uncertain about what delivery route to choose, in case they had the choice; their demographic characteristics, attitudes toward birth issues and their Wijma Delivery Expectancy/Experience Questionnaire A scores, compared with women consistent in their preference for vaginal delivery. Of the 413 respondents, 365 (88.4%) were consistent in their preference for vaginal delivery. In logistic regression models the important contributors to describing preferences for cesarean section or uncertain preferences were previous cesarean section and maternal belief that cesarean section is more beneficial than vaginal delivery. The majority of pregnant women preferred vaginal delivery to cesarean section. Neither a higher Wijma Delivery Expectancy/Experience Questionnaire A score nor sociodemographic differences were important determinants of a preference for cesarean section or for an uncertain preference. On the other hand, previous cesarean section and certain preconceived maternal attitudes towards delivery were characteristic for these women. © 2014 Nordic Federation of Societies of Obstetrics and Gynecology.

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

    Directory of Open Access Journals (Sweden)

    Godrat Akhavanakbari

    2013-01-01

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

  20. Cesarean section may increase the risk of both overweight and obesity in preschool children.

    Science.gov (United States)

    Rutayisire, Erigene; Wu, Xiaoyan; Huang, Kun; Tao, Shuman; Chen, Yunxiao; Tao, Fangbiao

    2016-11-03

    The increase rates of cesarean section (CS) occurred at the same period as the dramatic increase of childhood overweight/obesity. In China, cesarean section rates have exponentially increased in the last 20 years and they now exceed World Health Organization (WHO) recommendation. Such high rates demand an understanding to the long-term consequences on child health. We aim to examine the association between CS and risk of overweight and obesity among preschool children. We recruited 9103 children from 35 kindergartens in 4 cities located in East China. Children anthropometric measurements were taken in person by trained personnel. The mode of delivery was classified as vaginal or CS, in sub-analyses we divided cesarean delivery into elective or non-elective. The mode of delivery and other parental information were self-reported by parents. Multivariate logistic regression analysis was used to examine the associations. In our cross-sectional study of 8900 preschool children aged 3-6 years, 67.3 % were born via CS, of whom 15.7 % were obese. Cesarean delivery was significantly associated with the risk of overweight [OR 1.24; (95 % CI 1.07-1.44); p = 0.003], and the risk of obesity [OR 1.29; (95 % CI 1.13-1.49); p children. After adjusted for child characteristics, parental factors and family income, the odd of overweight was 1.35 and of obesity was 1.25 in children delivered by elective CS. The associations between CS and overweight/obesity in preschool children are influenced by potential confounders. Both children delivered by elective or non-elective CS are at increased risk of overweight/obesity. Potential consequences of CS on the health of the children should be discussed among both health care professionals and childbearing women.

  1. Comparison of Oral Intake Profiles at 2 and 8 Hours following Cesarean Section under Spinal Anesthesia

    Directory of Open Access Journals (Sweden)

    Arbabi Kalati Farshid

    2010-03-01

    Full Text Available Background: After cesarean section, practices vary considerably between institutions and individual practitioners, ranging from early oral fluids or food to delayed introduction of oral fluids and food which may be after 24 hours or more. This study was carried out to assess and compare the outcome, length of hospital stay and maternal satisfaction of early (2 hours and late (8 hours postoperative feeding after uncomplicated cesarean section done under spinal anesthesia. Materials and Methods: In this randomized clinical trial, 112 women undertaking uncomplicated cesarean section under regional anesthesia from August 2008 to August 2009 were randomly assigned to early feeding ( 2 hours after operation and late feeding (conventional 8 hours after operation groups. Two groups were compared for the occurrence of postoperative outcome, possible complications, length of hospital stay and patient´s satisfaction. Chi Squared and t-tests were used to analyze the data. Statistical significance was set at P< 0.05.Results: There were no significant differences in the demographic data and operation variables between the two groups. No significant differences were noted between the groups regarding post feeding nausea and vomiting, post operative ileus and other complications and duration of hospitalization. Compared with the late postoperative feeding, the early feeding group had a shorter mean time to first flatus (P=0.03 and higher satisfaction rate (P<0.0001. Conclusion: Early feeding (2 hours after uncomplicated cesarean in low-risk woman is associated with higher maternal satisfaction without higher rates of gastrointestinal and non gastrointestinal complications

  2. Prevalence of and risk factors associated with cesarean section in Lebanon - A retrospective study based on a sample of 29,270 women.

    Science.gov (United States)

    Zgheib, Sandy M; Kacim, Mohammad; Kostev, Karel

    2017-12-01

    During the last decades, there has been an alarming and dramatic increase in the number of cesarean births in both developed and undeveloped countries. This increase has not been clinically justified but, nevertheless, has raised an important number of issues. The aim of this study was to determine the risk factors associated with the high cesarean section rates in Lebanon. This study is based on a sample of 29,270 Lebanese women who were pregnant between 2000 and 2015. Among these, 14,327 gave birth by cesarean section and 14,943 gave birth vaginally. To identify the risk factors of cesarean section, logistic regression was applied as a statistical method using the SPSS statistical package. Of the 29,270 pregnant women included in the study, 49% had cesarean sections while 51% gave birth vaginally. Repeat cesarean section accounted for 23% while vaginal birth after cesarean accounted for only 0.2% of deliveries. In addition, weekdays were associated with a preference of providers to carry out more cesarean sections. According to an analysis of our data using logistic regression, the risk factors associated with the increase in cesarean section rates were advanced maternal age, elective cesarean section, malpresentation of fetus, multiple birth, prolonged pregnancy, prolonged labor, and fetal distress. Based on these results, it is recommended that a new health policy be implemented to reduce the number of unnecessary cesarean deliveries in Lebanon. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  3. Maternal and Fetal Effect of Misgav Ladach Cesarean Section in ...

    African Journals Online (AJOL)

    Background: The poor utilisation of the Misgav-Ladach (ML) caesarean section method in our environment despite its proven advantage has been attributed to several factors including its non-evaluation. A well designed and conducted trial is needed to provide evidence to convince clinician of its advantage over ...

  4. The effects of religion and spirituality on postoperative pain, hemodynamic functioning and anxiety after cesarean section.

    Directory of Open Access Journals (Sweden)

    Siavash Beiranvand

    2014-12-01

    Full Text Available Spiritual elements play an important role in the recovery process from acute postoperative pain. This study was conducted to assess the effect of pray meditation on postoperative pain reduction and physiologic responds among muslim patients who underwent cesarean surgery under spinal anesthesia. This double-blinded randomized clinical trial study was conducted among muslim patients who underwent cesarean surgery under spinal anesthesia during 2011-2013 at tertiary regional and teaching hospital in Lorestan, Iran. The patients were randomly divided into interventional group (n=80 and control group (n=80. For about 20 minutes using a disposable phone mentioned and listened to pray meditation "Ya man esmoho davaa va zekroho shafa, Allahomma salle ala mohammad va ale mohammad" in interventional group and phone off in control group. Before and during pray meditation, 30, 60 minutes, 3 and 6 hours after pray meditation pain intensity, blood pressure, heart rate and respiratory rate were measured. No statistically significant improvement in pain score was found before and during pray meditation, 30, 60 minutes after pray meditation (P>0.05. Statistically significant improvement in pain score was found at 3 and 6 hours after pray meditation than control group (1.5 ± 0.3 vs. 3 ± 1.3, P=0.030 and (1.3 ± 0.8 vs. 3 ± 1.1, P=0.003. However, there was no significant difference in the physiological responses (systolic and diastolic blood pressure, respiration, and heart rate any time between the groups. Religion and spirituality intervention such as pray meditation could be used as one of non-pharmacological pain management techniques for reducing pain after cesarean surgery. Also, Pray meditation provides less postoperative nausea and vomiting (PONV and more relaxation.

  5. The effects of religion and spirituality on postoperative pain, hemodynamic functioning and anxiety after cesarean section.

    Science.gov (United States)

    Beiranvand, Siavash; Noparast, Morteza; Eslamizade, Nasrin; Saeedikia, Saeed

    2014-01-01

    Spiritual elements play an important role in the recovery process from acute postoperative pain. This study was conducted to assess the effect of pray meditation on postoperative pain reduction and physiologic responds among muslim patients who underwent cesarean surgery under spinal anesthesia. This double-blinded randomized clinical trial study was conducted among muslim patients who underwent cesarean surgery under spinal anesthesia during 2011-2013 at tertiary regional and teaching hospital in Lorestan, Iran. The patients were randomly divided into interventional group (n=80) and control group (n=80). For about 20 minutes using a disposable phone mentioned and listened to pray meditation "Ya man esmoho davaa va zekroho shafa, Allahomma salle ala mohammad va ale mohammad" in interventional group and phone off in control group. Before and during pray meditation, 30, 60 minutes, 3 and 6 hours after pray meditation pain intensity, blood pressure, heart rate and respiratory rate were measured. No statistically significant improvement in pain score was found before and during pray meditation, 30, 60 minutes after pray meditation (P>0.05). Statistically significant improvement in pain score was found at 3 and 6 hours after pray meditation than control group (1.5 ± 0.3 vs. 3 ± 1.3, P=0.030) and (1.3 ± 0.8 vs. 3 ± 1.1, P=0.003). However, there was no significant difference in the physiological responses (systolic and diastolic blood pressure, respiration, and heart rate) any time between the groups. Religion and spirituality intervention such as pray meditation could be used as one of non-pharmacological pain management techniques for reducing pain after cesarean surgery. Also, Pray meditation provides less postoperative nausea and vomiting (PONV) and more relaxation.

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

    Science.gov (United States)

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

    2013-01-01

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

  7. Impact of cesarean section in a private health service in Brazil: indications and neonatal morbidity and mortality rates.

    Science.gov (United States)

    Almeida, M A; Araujo Júnior, E; Camano, L; Peixoto, A B; Martins, W P; Mattar, R

    2018-01-01

    To evaluate the incidence of, indications of, and maternal and neonatal morbidity and mortality rates in cesarean sections in a private health service in Brazil. Retrospective and observational study. Private health service in Vitória, Espírito Santo, Brazil. The patients were interviewed using a structured questionnaire to determine maternal age, gestational age at the time of delivery, number of previous deliveries, type of delivery performed, duration of labor, indications for cesarean delivery, point at which cesarean section was performed, physician responsible for delivery, and maternal morbidity, fetal morbidity, and fetal mortality rates. A descriptive analysis of the data was conducted. Students t-test was performed to compare quantitative variables, and Fishers exact test was performed for categorical variables. A total of 584 patients were evaluated. Of these, 91.8% (536/584) had cesarean sections, while only 8.2% (48/584) had vaginal deliveries. There were no reports of forceps-assisted vaginal deliveries. In 87.49% of the deliveries, the number of gestational weeks was more than 37. In terms of indications for performing cesarean section, 48.5% were for maternal causes, 30.41% were for fetal causes, and 17.17% were elective. Maternal re-hospitalization due to puerperal complications was necessary in 10.42% of the vaginal deliveries and in 0.93% of the cesarean deliveries (pcesarean section. Of the newborns with complications at birth, 40.59% (41/101) had to be admitted to the neonatal intensive care unit. There were no cases of maternal death. There were seven cases of fetal/neonatal death. We observed that the vast majority of deliveries in the private sector are performed by cesarean section, without labor, and by the patients obstetrician. We found no serious maternal complications or increased neonatal morbidity rates associated with cesarean section.

  8. Effect of cesarean section on relapse of childhood idiopathic nephrotic syndrome.

    Science.gov (United States)

    Kimata, Takahisa; Kino, Jiro; Yamanouchi, Sohsaku; Suruda, Chikushi; Tsuji, Shoji; Kaneko, Kazunari

    2017-10-01

    In parallel with the increase in the prevalence of childhood chronic diseases, the rate of cesarean delivery has risen during the past decades. This study tested the hypothesis that children delivered by cesarean section (CS) have a higher risk of relapse of idiopathic nephrotic syndrome (INS). Fifty-six children with INS were categorized into three groups. Group A consisted of patients with INS who had no relapses after the onset of INS; group B consisted of patients with INS who had infrequent relapse; and group C consisted of patients with INS who had frequent relapse. The number of enrolled patients in groups A, B, and C was 10, 14, and 32, respectively. The ratio of neonates delivered via CS was significantly higher in group C (37.5%, P childhood INS. © 2017 Japan Pediatric Society.

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

    Directory of Open Access Journals (Sweden)

    M Mojibian

    2013-08-01

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

  10. The Effect of Supportive Counseling on the Symptoms of Acute Stress Disorder Following Emergency Cesarean Section

    Directory of Open Access Journals (Sweden)

    Marzieh Mojrian

    2018-04-01

    Full Text Available Background & aim: Adverse childbirth experiences can lead to the emergence of mental disorders, such as acute stress disorder (ASD, in mothers in the postpartum period. Birth trauma can occur following aggressive procedures such as emergency cesarean section. This study aimed to determine the effect of supportive counseling intervention on the symptoms of ASD in women after emergency cesarean delivery. Methods: This randomized clinical trial was conducted on 126 women with traumatic emergency cesarean section at Payambar-E Azam and Afzalipoor hospitals in Kerman, Iran. The participants were selected based on DSM-IV criteria. The subjects were randomly divided into the intervention and control groups. The intervention group received individual and face-to-face supportive counseling. The data collection tool was the Acute Stress Disorder Questionnaire, which was completed one and three weeks post-intervention. The data were analyzed using descriptive and inferential statistics by SPSS, version 13. Results: The two groups were comparable in terms of demographic characteristics, pregnancy complications, and midwifery history. Also, there was no significant difference between two groups regarding the depression and anxiety mean scores at the pre-intervention stage. The results revealed a statistically significant difference between the control and intervention groups in terms of all acute stress disorder symptoms after one and three weeks of the intervention (P

  11. Antibiotic prophylaxis and inflammatory complications after Cesarean section

    Directory of Open Access Journals (Sweden)

    Hasan Karahasan

    2011-12-01

    Full Text Available Introduction: Gynaecological and obstetric surgeries are high risk operations for the development of postoperative inflammatory complications due to the proximity of the genitourinary tract. The aim of this study was to compare the frequency of inflammatory complications in emergency or elective cases of caesarean sections as well as the frequency of complications related to the method of surgical treatment used.Methods: We analyzed inflammatory complications in 450 caesarean sections, which developed in a one year period from June 1st, 2000. to June 1st 2001. Patients were grouped according to the method of the surgery, and on emergency or elective case. Misgav Ladach or Dorfler surgical methods were used.Results: The most common inflammatory complication was wound infection and the most common risk factors for inflammatory complications were premature rupture of membranes and anemia.Conclusions: Long term use of one antibiotic was the most commonly implemented form of antibiotic prophylaxis.

  12. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study.

    Science.gov (United States)

    Farret, Túlio Cícero Franco; Dallé, Jessica; Monteiro, Vinícius da Silva; Riche, Cezar Vinícius Würdig; Antonello, Vicente Sperb

    2015-01-01

    The present study evaluated patients with diagnosis of surgical site infection (SSI) following cesarean section and their controls to determinate risk factors and impact of antibiotic prophylaxis on this condition. All cesareans performed from January 2009 to December 2012 were evaluated for SSI, based on criteria established by CDC/NHSN. Control patients were determined after inclusion of case patients. Medical records of case and control patients were reviewed and compared regarding sociodemographic and clinical characteristics. Our study demonstrated an association following univariate analysis between post-cesarean SSI and number of internal vaginal examinations, time of membrane rupture, emergency cesarean and improper use of antibiotic prophylaxis. This same situation did not repeat itself in multivariate analysis with adjustment for risk factors, especially with regard to antibiotic prophylaxis, considering the emergency cesarean factor only. The authors of the present study not only question surgical antimicrobial prophylaxis use based on data presented here and in literature, but suggest that the prophylaxis is perhaps indicated primarily in selected groups of patients undergoing cesarean section. Further research with greater number of patients and evaluated risk factors are fundamental for better understanding of the causes and evolution of surgical site infection after cesarean delivery. Copyright © 2014. Published by Elsevier Editora Ltda.

  13. [Early resumption of food intake after cesarean section in black African women: liquid versus solid food].

    Science.gov (United States)

    Zoumenou, E; Denakpo, J L; Assouto, P; Tchaou, B; Lokossou, T; Chobli, M

    2011-04-01

    The purpose of this study was to compare the effects of early resumption of solid versus liquid food intake after emergency cesarean section in black African women, in terms of gastrointestinal complications and maternal satisfaction. A total of 120 patients were randomly distributed into two groups of 60 each. In group L, liquid food intake in the form of sweetened citronella drink was allowed at will starting 6 six hours after the procedure but no solid food was allowed for 24 hours. In group S, normal solid food intake was resumed six hours after the procedure. The two study groups were not significantly different with regard to age, medical history, ASA class, obstetrical status, indications for cesarean section, anesthetic protocol, mean procedural duration, and postoperative analgesia. Study variables included tolerance of food intake, gastro-intestinal complications, time necessary to resume full activity and patient satisfaction. Overall, 6% of patients reported complications involving nausea, vomiting and bloating. There was no statistical difference between the two groups. Normal intestinal transit resumed earlier in group S but the difference was not significant. Auscultation of the abdomen at 16 hours after the procedure demonstrated presence of peristalsis in 59 patients in group S and 51 in group L (p = 0.008). The maternal satisfaction rate was 92% in group S and 43% in group L (p food in case of future cesarean. Early solid food intake after cesarean in black African women is as well tolerated as early liquid feeding. Resumption of solid food intake allows earlier rehabilitation and improves patient satisfaction.

  14. [Risk of materno-fetal transmission of the HIV infection with antiretroviral therapy and cesarean section: experience of the Parma group].

    Science.gov (United States)

    Magnani, G; Degli Antoni, A M; Cocca, G; Zoncada, A; Cavatorta, E; Grignaffini, A; Verrotti, C; Soncini, E; Pedicelli, A; Fieni, S; Bussolati, G; Gambini, L; Ndongko, A; Bengalia, G; Dodi, I

    2000-01-01

    Vertical transmission of HIV is by far the most important way of infection in pediatric patients. Transmission rate of infection varies between 15-40% in the absence of antiretroviral prophylaxis. Only 2% of infected pregnant women who underwent caesarean section and zidovudine treatment transmitted the infection to their newborns. From January 1995 to September 2000 twenty seropositive pregnant women and their twenty newborns were followed at the Azienda Ospedaliera of Parma. Nine women (45%) were treated with only zidovudine according to the ACTG 076 protocol; eight women (40%) continued the treatment they were assuming before pregnancy with the eventual addition of zidovudine. 3 women (15%) were not treated because HIV infection was only detected after delivery. 15 women underwent caesarean section, in 13 cases in association to antiretroviral prophylaxis: in the remaining 2 cases no intrapartum treatment was started due to the urgency of delivery. The rate of vertical transmission among the 20 women was 5% (1/20), significantly less then that observed (20.5%) among 31 pregnant HIV women followed in Parma from January 1987 to December 1994 and not treated with antiretroviral prophylaxis and/or cesarean section (Magnani G. Personal data). The only infected baby was born by vaginal delivery. No transmission was observed in the group of pregnant women who underwent the combination of antiretroviral prophylaxis and cesarean section.

  15. Laparoscopic repair of a symptomatic post-cesarean section isthmocele: a video case report.

    Science.gov (United States)

    Aimi, Giorgio; Buggio, Laura; Berlanda, Nicola; Vercellini, Paolo

    2017-06-01

    To describe our technique for laparoscopic management of post-cesarean section isthmocele. Surgical video article. Local Institutional Review Board approval for the video reproduction has been obtained. University hospital. A 36-year-old patient with a history of two previous cesarean deliveries. She complained of persistent postmenstrual spotting and chronic pelvic pain. At transvaginal ultrasound examination, a cesarean scar defect of 20.0 × 15.6 mm was identified, with a residual myometrial thickness over the defect of 2.6 mm. Repair of isthmocele and relief of pain. Isthmocele excision and myometrial repair was performed laparoscopically. The first step of the procedure was the cautious mobilization of the bladder from its adhesions with the site of the previous cesarean scar. Subsequently, the isthmocele site was identified with the aid of intraoperative transrectal ultrasonography. Transrectal ultrasonographic assistance is particularly important when a bulge of the cesarean scar is not laparoscopically visible. Once identified, the isthmocele pouch was incised and its pitchy content drained. Then the cesarean scar was excised with cold scissors, avoiding cauterization to reduce the risk of tissue necrosis. This step is considered completed when the whitish scar tissue of the isthmocele site margins are no longer present and reddish healthy myometrium is visualized. Before suturing the defect, a Hegar dilator was placed into the cervix with the aim of maintaining the continuity between the cervical canal and the uterine cavity. Then, the myometrial repair was performed with the use of a single layer of interrupted 2-0 Vycril sutures. To limit tissue ischemia, we prefer not to add a second layer of sutures. Finally, the visceral peritoneum defect was closed, with the aim of restoring the physiologic uterine anatomy. In this case, multiple peritoneal endometriotic implants were also identified and excised. Operating time was 70 minutes. The postoperative

  16. [Multi-centric clinical study of trial of labor after cesarean section].

    Science.gov (United States)

    Yu, L; Su, C H; Wang, X Y; Gong, J J; Chen, P; Du, H M; Quan, Q H; Li, L L; Chen, D J

    2016-08-25

    To study the feasibility and safety of trial of labor after cesarean section (TOLAC). Retrospective analysis of five medical center of Guangdong province from January 2011 to December 2015 hospitalized delivery information, compare the same scar TOLAC (research group) with the scar pregnancy (control group) pregnancy outcomes, to study the feasibility and safety of TOLAC. (1) During 2011-2015, total delivery 95 600 cases in five medical center, 13 824 cases of thme with uterine scar pregnancy, including 12 027 cases elective repeat cesarean section and 1 797 cases (13.00%, 1 797/13 824) with scar uterus vaginal trial of labor. Among 1 308 cases of vaginal delivery, the success for trial of labor rate was 72.79% (1 308/1 797). From 2011 to 2015, there were increased rate of pregnancy after cesarean section, which were respectively 10.71%, 13.28%, 14.45%, 15.54% and 16.98%. The will of vaginal birth were rising and the rate were respectively 11.85%, 12.25%, 13.49%, 13.82% and 12.93%. (2) There were 489 (27.21%, 489/1 797) cases of scar uterus maternal emergency cesarean section in the trial of labor, reason for "social factors" require for cesarean delivery have 68 cases, the percentage was 13.91% (68/489), compared with control group (7.18%, 206/2 869), the difference was statistically significant difference (χ(2)=27.356, P=0.000). Doctors diagnosed as "aura uterine rupture" in the labor was 11.86% (58/489), compared with that in control group (1.43%, 41/2 869), the differences were statistically significant difference (χ(2)=1 578.223, P=0.000). (3) The incidence of uterine rupture of the research group (0.74%, 9/1 211) was significantly higher than that of control group (0.01%,2/31 200; χ(2)> 2 000, P=0.000). The incidence of postpartum hemorrhage in research group was 6.94% (84/1 211), compared with that in the control group (3.05%, 951/31 200), there was statistically significant difference (χ(2)=16.328, P=0.000). While, there were no statistical

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

    DEFF Research Database (Denmark)

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

    1994-01-01

    Fifty-eight Danish maternity units, managing 99% of Danish deliveries, participated in a cross sectional study to assess the relationship between use of birth-related technologies, cesarean section rates and perinatal mortality for births after 35 completed weeks of gestation. A regional technology...... index (0-10) was calculated for each maternity unit according to its use of ante and intra partum fetal heart rate monitoring (FHM), hormone analysis (human placental lactogen (HPL) and/or estriol (O3)), fetal blood samples (scalp-pH), intrauterine catheter and umbilical cord-pH. Maternity units using...

  18. Does ST analysis of fetal ECG reduce cesarean section rate for fetal distress?

    Science.gov (United States)

    Straface, Gianluca; Scambia, Giovanni; Zanardo, Vincenzo

    2017-08-01

    Each pregravidic, gestational or intrapartum complication may, per se, have a different impact on the operative delivery rate, regardless of which fetal monitoring system was adopted. We wanted to verify if CTG plus ST interval analysis (STAN) of fetal ECG might be able to reduce the number of operative delivery for fetal distress in high-risk pregnancies compared to low-risk women monitored with CTG alone. In this cohort study, we evaluated 100 high-risk pregnancies consecutively with STAN® S31 (Neoventa Medical, Gotenburg, Sweden) and 160 low-risk pregnancies consecutively with continuous CTG (Hewlett Packard, 50 IP, Palo Alto, CA). We found that STAN monitoring, although associated with a higher total operativity rate, both vaginal (11% versus 3.12%, p = 0.015) and cesarean (17% versus 4.37%, p = 0.001), reduced the cesarean section rate performed for fetal distress (29.41% versus 85.71%, p = 0.023) compared with low-risk CTG monitoring group. CTG plus ST interval analysis of fetal ECG reduced the risk of operative cesarean delivery for fetal distress in high-risk gestations.

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

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    Mitra Jabalameli

    2014-01-01

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

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

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    M Amiri-Siavoshani

    2016-10-01

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

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

    Science.gov (United States)

    2017-01-30

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

  2. Cesarean Myomectomy Outcome in a Nigerian District Hospital ...

    African Journals Online (AJOL)

    Subjects and Methods: This was a prospective, descriptive study of all patients who underwent Cesarean Myomectomy between November 2011 and October 2012 in a Obio Cottage Hospital, Port Harcourt, Nigeria. Myomectomy done at the time of Cesarean section (CS). The main outcome measures were number, ...

  3. Effects of intrathecal dexmedetomidine on shivering after spinal anesthesia for cesarean section: a double-blind randomized clinical trial

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    Nasseri K

    2017-04-01

    Full Text Available Karim Nasseri,1,2 Negin Ghadami,1 Bijan Nouri2 1Department of Anesthesiology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran; 2Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran Background: Shivering is among the common troublesome complications of spinal anesthesia (SA, and causes discomfort and discontentment in parturients undergoing cesarean sections (CSs. The aim of this study was to investigate the effects of intrathecal dexmedetomidine in the prevention of shivering in those who underwent CS under SA.Subjects and methods: Fifty parturients planned for elective CSs under SA were enrolled in this prospective, double-blinded, controlled study and randomly divided into two equal groups. Spinal block was achieved with 12.5 mg 0.5% heavy bupivacaine plus 5 µg dexmedetomidine (BD group or 0.5 mL 0.9% normal saline (BN group. The incidence and intensity of shivering, peripheral and core body temperature, hemodynamic parameters, and adverse events was recorded.Results: The incidence of shivering was significantly higher in the BN group (52% than the BD group (24% (P=0.04. Likewise, the intensity of shivering was significantly higher in the BN group than the BD group (P=0.04. The incidence of adverse events, such as hypotension, nausea/vomiting, and bradycardia, was not significantly different between the two groups, although the grade of sedation was higher in the BD group than the BN group (P=0.004.Conclusion: We conclude that intrathecal dexmedetomidine is effective in lowering the incidence and intensity of shivering in parturients undergoing CSs under SA without major adverse effects. Keywords: dexmedetomidine, shivering, spinal anesthesia, cesarean sections, bupivacaine

  4. Is sonographically measured cervical length at 37 weeks of gestation associated with intrapartum cesarean section? A prospective cohort study.

    Science.gov (United States)

    de Vries, Bradley; Narayan, Rajit; McGeechan, Kevin; Santiagu, Stanley; Vairavan, Ramesh; Burke, Minke; Phipps, Hala; Hyett, Jon

    2018-02-16

    Cesarean section rates continue to increase globally. Prediction of intrapartum cesarean section could lead to preventive measures. Our aim was to assess the association between sonographically measured cervical length at 37 weeks of gestation and cesarean section among women planning a vaginal birth. The population was women with a low-risk pregnancy or with gestational diabetes. This was a prospective cohort study conducted in a tertiary referral hospital in Sydney, Australia. In all, 212 women with a low-risk pregnancy or with gestational diabetes were recruited including 158 nulliparous and 54 parous women. Maternal demographic, clinical and ultrasound characteristics were collected at 37 weeks of gestation. Semi-Bayesian logistic regression and Markov chain Monte Carlo simulation were used to assess the relationship between cervical length and cesarean section in labor. Rates of cesarean section were 5% (2/55) for cervical length ≤20 mm, 17% (17/101) for cervical length 20-32 mm, and 27% (13/56) for cervical length >32 mm. These rates were 4, 22 and 33%, respectively, in nulliparous women. In the semi-Bayesian analysis, the odds ratio for cesarean section was 6.2 (95% confidence interval 2.2-43) for cervical length 20-32 mm and 10 (95% confidence interval 4.8-74) for cervical length >32 mm compared with the lowest quartile of cervical length, after adjusting for maternal age, parity, height, prepregnancy body mass index, gestational diabetes, induction of labor, neonatal sex and birthweight centile. Cervical length at 37 weeks of gestation is associated with intrapartum cesarean section. © 2018 Nordic Federation of Societies of Obstetrics and Gynecology.

  5. Is the biparietal diameter of fetuses in late gestation too variable to predict readiness for cesarean section in dogs?

    Science.gov (United States)

    De Cramer, K G M; Nöthling, J O

    2018-06-01

    Correct assessment of readiness for cesarean section is essential for timing elective cesarean section during late pregnancy in the bitch. In humans, biparietal diameter is sufficiently precise and accurate and used in a clinical setting daily. The objectives of this study were to determine whether fetal biparietal diameter in late gestation in the dog could be used to predict readiness for cesarean section by having reached a minimum cut-off value and to correlate the biparietal diameter to birth weight. The biparietal diameter of 208 puppies in 34 litters from 31 English bulldog bitches and 660 puppies in 78 litters from 70 Boerboel bitches were measured immediately after delivery by cesarean section, performed at full term, using digital calipers. At the same time the birth weight of the same 208 English bulldog puppies and 494 of the same Boerboel puppies in 59 litters from 54 bitches was measured by means of an electronic scale. With a cesarean section, all the puppies in a litter are delivered simultaneously and readiness for cesarean section must be determined for a litter. The minimum, median and maximum biparietal diameter varied from 21.1 to 47.8, 32.9 to 50.0 and 34.2-58.2 mm, respectively, among English bulldog litters and from 18.4 to 48.7, 35.5 to 49.7 and 39.8-54.3 mm among Boerboel litters. This large variation suggests that biparietal diameter is too variable within and among litters to be useful as a means of determining readiness for cesarean section. Copyright © 2018 Elsevier Inc. All rights reserved.

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

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    Sinéad M O'Neill

    2014-07-01

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

  7. Cesarean Section and Rate of Subsequent Stillbirth, Miscarriage, and Ectopic Pregnancy: A Danish Register-Based Cohort Study

    Science.gov (United States)

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

    2014-01-01

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

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

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    Okonkwo NS

    2012-03-01

    Full Text Available Ngozi S Okonkwo1, Oladosu A Ojengbede2, Imran O Morhason-Bello1, Babatunde O Adedokun31Department of Obstetrics and Gynecology, University College Hospital; 2Center for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan; 3Department of Epidemiology, Medical Statistics, and Environmental Health, College of Medicine, Ibadan, Oyo State, NigeriaBackground: Contrary to the widely reported aversion to cesarean section in the West African subregion, maternal demand for cesarean section (MDCS seems to be on the increase, and there is little evidence to explain this trend. The purpose of this study was to determine the perception and attitudes of Nigerian antenatal clients towards MDCS, their willingness to request MDCS, and the relationship between willingness to request MDCS and sociodemographic characteristics.Methods: A cross-sectional survey was undertaken among 843 antenatal clients at Agbongbon/Orayan primary health care centers (PHCs, Adeoyo Maternity Hospital (SHC, and UCH Ibadan (THC, representing the three different levels of health care in Nigeria, ie, primary, secondary, and tertiary.Results: The proportion of women aware of MDCS was 39.6%. Predictors of awareness were education and type of health facility. Women from THC and those with tertiary education and above were more likely to be aware of MDCS than others (P = 0.001. Doctors were major sources of information on MDCS (30.8% as well as friends (24.3%. Common reasons reported for MDCS were fear of labor pains (68.9%, and fear of poor labor outcome (60.1%, and fear of fecal (20.2% and urinary incontinence (16.8%. More women from the THC than other facilities believed that requests for MDCS should be granted (P < 0.001. However, willingness to request MDCS was low (6.6%. More than 50% of those willing to request MDCS would likely be criticized, mainly by their husbands. On multiple logistic regression, respondents at the THC were significantly more

  9. A clinical evaluation of interventional embolization in hemorrhage after cesarean section followed by DIC

    International Nuclear Information System (INIS)

    Yang Kui; Yin Jun; Luo Jun; Jin Xueguang; Liu Zaijie; Liang Yong; Huang Lexiu

    2005-01-01

    Objective: To investigate the clinical characteristics of cesarean section (C-section) complicating with DIC and evaluate the interventional embolization as a treatment of post-C-section hemorrhage. Methods: In total 12 cases of post-C-section massive hemorrhage and DIC were retrospectively studied. Results: Hemostasia was successfully obtained after intervention in all patients. Bleeding was immediately ceased after the procedure in 10 cases out of 12, and bleeding was significantly decreased after intervention, which stop gradually within 3 and 7 days in other 2 cases. Excellent prognosis was arcbieved in all cases. Conclusion: Post-C-section bleeding with DIC is characterized by massive blood loss and progressive deterioration of the patients condition. Interventional embolization provides a quick, thorough, lasting, safe and reliable control of the bleeding, with which uterectomy is able to be avoid. (authors)

  10. Cesarean section delivery and development of food allergy and atopic dermatitis in early childhood.

    Science.gov (United States)

    Papathoma, Evangelia; Triga, Maria; Fouzas, Sotirios; Dimitriou, Gabriel

    2016-06-01

    Delivery by Cesarean section (CS) may predispose to allergic disorders, presumably due to alterations in the establishment of normal gut microbiota in early infancy. In this study, we sought to investigate the association between CS and physician-diagnosed food allergy and atopic dermatitis during the first 3 years of life, using data from a homogeneous, population-based, birth cohort. A total of 459 children born and cared for in the same tertiary maternity unit were examined at birth and followed up at 1, 6, 12, 18, 24, 30 and 36 months of age. Participants with symptoms suggestive of food allergy or atopic dermatitis were evaluated by a pediatric allergy specialist to confirm the diagnosis based on well-defined criteria. The rate of CS was 50.8% (n = 233). Food allergy was diagnosed in 24 participants (5.2%) while atopic dermatitis was diagnosed in 62 children (13.5%). Cesarean section (OR 3.15; 95% CI 1.14-8.70), atopic dermatitis of the child (OR 3.01; 95% CI 1.18-7.80), parental atopy (OR 4.33; 95% CI 1.73-12.1), and gestational age (OR 1.57; 95% CI 1.07-2.37) were significant and independent predictors of food allergy. Children with at least one allergic parent delivered by CS had higher probability of developing food allergy compared with vaginally delivered children of non-allergic parents (OR 10.0; 95% CI 3.06-32.7). Conversely, the effect of CS on atopic dermatitis was not significant (OR 1.35; 95% CI 0.74-2.47). Delivery by CS predisposes to the development of food allergy but not atopic dermatitis in early childhood. Cesarean section delivery seems to upregulate the immune response to food allergens, especially in children with allergic predisposition. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. Relation between Birth Weight and Intraoperative Hemorrhage during Cesarean Section in Pregnancy with Placenta Previa.

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    Hiroaki Soyama

    Full Text Available Placenta previa, one of the most severe obstetric complications, carries an increased risk of intraoperative massive hemorrhage. Several risk factors for intraoperative hemorrhage have been identified to date. However, the correlation between birth weight and intraoperative hemorrhage has not been investigated. Here we estimate the correlation between birth weight and the occurrence of intraoperative massive hemorrhage in placenta previa.We included all 256 singleton pregnancies delivered via cesarean section at our hospital because of placenta previa between 2003 and 2015. We calculated not only measured birth weights but also standard deviation values according to the Japanese standard growth curve to adjust for differences in gestational age. We assessed the correlation between birth weight and the occurrence of intraoperative massive hemorrhage (>1500 mL blood loss. Receiver operating characteristic curves were constructed to determine the cutoff value of intraoperative massive hemorrhage.Of 256 pregnant women with placenta previa, 96 (38% developed intraoperative massive hemorrhage. Receiver-operating characteristic curves revealed that the area under the curve of the combination variables between the standard deviation of birth weight and intraoperative massive hemorrhage was 0.71. The cutoff value with a sensitivity of 81.3% and specificity of 55.6% was -0.33 standard deviation. The multivariate analysis revealed that a standard deviation of >-0.33 (odds ratio, 5.88; 95% confidence interval, 3.04-12.00, need for hemostatic procedures (odds ratio, 3.31; 95% confidence interval, 1.79-6.25, and placental adhesion (odds ratio, 12.68; 95% confidence interval, 2.85-92.13 were independent risk of intraoperative massive hemorrhage.In patients with placenta previa, a birth weight >-0.33 standard deviation was a significant risk indicator of massive hemorrhage during cesarean section. Based on this result, further studies are required to

  12. Relation between Birth Weight and Intraoperative Hemorrhage during Cesarean Section in Pregnancy with Placenta Previa.

    Science.gov (United States)

    Soyama, Hiroaki; Miyamoto, Morikazu; Ishibashi, Hiroki; Takano, Masashi; Sasa, Hidenori; Furuya, Kenichi

    2016-01-01

    Placenta previa, one of the most severe obstetric complications, carries an increased risk of intraoperative massive hemorrhage. Several risk factors for intraoperative hemorrhage have been identified to date. However, the correlation between birth weight and intraoperative hemorrhage has not been investigated. Here we estimate the correlation between birth weight and the occurrence of intraoperative massive hemorrhage in placenta previa. We included all 256 singleton pregnancies delivered via cesarean section at our hospital because of placenta previa between 2003 and 2015. We calculated not only measured birth weights but also standard deviation values according to the Japanese standard growth curve to adjust for differences in gestational age. We assessed the correlation between birth weight and the occurrence of intraoperative massive hemorrhage (>1500 mL blood loss). Receiver operating characteristic curves were constructed to determine the cutoff value of intraoperative massive hemorrhage. Of 256 pregnant women with placenta previa, 96 (38%) developed intraoperative massive hemorrhage. Receiver-operating characteristic curves revealed that the area under the curve of the combination variables between the standard deviation of birth weight and intraoperative massive hemorrhage was 0.71. The cutoff value with a sensitivity of 81.3% and specificity of 55.6% was -0.33 standard deviation. The multivariate analysis revealed that a standard deviation of >-0.33 (odds ratio, 5.88; 95% confidence interval, 3.04-12.00), need for hemostatic procedures (odds ratio, 3.31; 95% confidence interval, 1.79-6.25), and placental adhesion (odds ratio, 12.68; 95% confidence interval, 2.85-92.13) were independent risk of intraoperative massive hemorrhage. In patients with placenta previa, a birth weight >-0.33 standard deviation was a significant risk indicator of massive hemorrhage during cesarean section. Based on this result, further studies are required to investigate whether

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

    Directory of Open Access Journals (Sweden)

    Francesca Gatti

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    N. Manouchehrian

    2015-01-01

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

  15. 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

  16. Cesarean section and right femur fracture: a rare but possible complication for breech presentation.

    Science.gov (United States)

    Capobianco, Giampiero; Virdis, Giuseppe; Lisai, Pietro; Cherchi, Claudio; Biasetti, Ornella; Dessole, Francesco; Meloni, Giovanni Battista

    2013-01-01

    Background. The breech extraction of the fetus through the vagina has a greater risk of hip fracture compared with the extraction by abdominal route. Case. A 2390 g female infant was delivered at 39 weeks by elective cesarean section for breech presentation. The newborn sustained a fracture of the right femur. A simple immobilization of the limb in extension led to a complete healing of the fracture without sequelae. Conclusion. Caesarean delivery reduces the risk of causing a traumatic injury of the newborn compared to vaginal delivery, especially with breech presentation but does not eliminate this possible accidental complication.

  17. An unusual case of asymptomatic hyperreactio luteinalis present at cesarean section of a spontaneous singleton pregnancy

    Directory of Open Access Journals (Sweden)

    Ahmed M. Abbas

    2017-06-01

    Full Text Available Hyperreactio Luteinalis (HL is a benign self-limited pregnancy-related condition characterized by bilateral ovarian enlargement with multiple theca lutein cysts. It is commonly associated with gestational trophoblastic diseases and multiple pregnancy. We report a rare case of HL discovered accidentally during cesarean section (CS of a spontaneously conceived normal singleton pregnancy. CS was performed due to fetal malpresentation and previously scarred uterus, and delivered a healthy male neonate. Expectant management was performed to permit conservation of both ovaries without unnecessary surgical intervention. The condition resolved within 6 weeks postpartum without adding morbidity to the patient.

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

    Directory of Open Access Journals (Sweden)

    Minal Harde

    2013-01-01

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

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

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    Uma Srivastava

    2014-01-01

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

  20. [Obstetrical outcome after a cesarean section before 28 weeks of gestation - a case-control study].

    Science.gov (United States)

    Eslier, M; Lemonnier, M; Koné, M; Roumieux, S; Dreyfus, M

    2016-11-01

    The aim of our study was to compare the mode of delivery after a caesarean performed before 28 weeks of gestation compared to a control group of patients who had a caesarean at term. Our secondary objective was to compare the risk of uterine rupture in these both groups. This retrospective case-control was realised in a level III maternal center between the 1st of January 2001 and the 31th of December 2010. All patients who underwent caesarean section between 22 and 28 weeks of gestation were included, regardless of the indication of caesarean section, their gender and type of pregnancy (single or multiple). The only exclusion criterion was the existence of a scarred uterus. Seventy-four patients were included in the case group and 144 in the control group. On the 74 patients who had a Caesarean before 28 weeks of gestation, 33 had a subsequent pregnancy and 31 have been studied. Twenty-four patients (77.4%) had a caesarean. Of the 7 patients (22.6%) having a vaginal attempt, the success rate was 100%. In the control group, 44 patients (30.6%) had a caesarean and 100 patients (69.4%) having a vaginal attempt, the success rate was 80%. No uterine rupture was found in both groups. Two cases of incomplete uterine rupture were found in each group. In our small series, the risk of uterine rupture was not increased compared to the group of patients having a caesarean section at term. In a subsequent pregnancy, the caesarean rate was significantly higher after a caesarean section before 28 weeks after a caesarean section performed at term. However, there is no contraindication against a vaginal attempt after a caesarean section performed before 28 weeks, except in the case of a corporeal cesarean section proved. It is therefore important to refer to the operative report of cesarean section to know whether there was or not the lower segment and the hysterotomy realized. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

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

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    Maria Isabel do Nascimento

    2014-03-01

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

  2. Measuring Coverage in MNCH: Validating Women’s Self-Report of Emergency Cesarean Sections in Ghana and the Dominican Republic

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    Tunçalp, Özge; Stanton, Cynthia; Castro, Arachu; Adanu, Richard; Heymann, Marilyn; Adu-Bonsaffoh, Kwame; Lattof, Samantha R.; Blanc, Ann; Langer, Ana

    2013-01-01

    Background Cesarean section is the only surgery for which we have nearly global population-based data. However, few surveys provide additional data related to cesarean sections. Given weaknesses in many health information systems, health planners in developing countries will likely rely on nationally representative surveys for the foreseeable future. The objective is to validate self-reported data on the emergency status of cesarean sections among women delivering in teaching hospitals in the capitals of two contrasting countries: Accra, Ghana and Santo Domingo, Dominican Republic (DR). Methods and Findings This study compares hospital-based data, considered the reference standard, against women’s self-report for two definitions of emergency cesarean section based on the timing of the decision to operate and the timing of the cesarean section relative to onset of labor. Hospital data were abstracted from individual medical records, and hospital discharge interviews were conducted with women who had undergone cesarean section in two hospitals. The study assessed sensitivity, specificity, and positive predictive value of responses to questions regarding emergency versus non-emergency cesarean section and estimated the percent of emergency cesarean sections that would be obtained from a survey, given the observed prevalence, sensitivity, and specificity from this study. Hospital data were matched with exit interviews for 659 women delivered via cesarean section for Ghana and 1,531 for the Dominican Republic. In Ghana and the Dominican Republic, sensitivity and specificity for emergency cesarean section defined by decision time were 79% and 82%, and 50% and 80%, respectively. The validity of emergency cesarean defined by operation time showed less favorable results than decision time in Ghana and slightly more favorable results in the Dominican Republic. Conclusions Questions used in this study to identify emergency cesarean section are promising but insufficient to

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

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    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.

  4. 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.

  5. The neonate cry after cesarean section and vaginal delivery during the first minutes of life.

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    Branco, Anete; Behlau, Mara; Rehder, Maria Inês

    2005-05-01

    Although the option for vaginal delivery is most physiological, the achievement of cesarean section is very common in Brazil. The neonate cry represents the beginning of both processes, physiological adaptation and human vocal communication. The cry emission depends on the functioning of respiratory and laryngeal muscles, which are controlled by the nervous system. The acoustic analysis of neonate cry is useful in the assessment of healthy babies and can be used to characterize the signals of diseases through a previously multidisciplinary diagnosis, with immediate medical intervention. The present study compared the acoustic cry characteristics of 30 healthy newborn after a cesarean section and 30 healthy newborn after a vaginal delivery, of both genders, from the exact moment of birth until the first 5 min of life. Using the softwares VOXMETRIA and GRAM, it was possible to analyze the duration, frequency, intensity, occurrence, localization and inspiratory phonation, besides the type of spectrographic tracings. The acoustic cry characteristics of newborns after a C section and a vaginal delivery could evidence not only harmonic, expiratory, acute and strong emissions, but also emissions rich in sounds and varied in types of melody. The differences found can be related to the physiology of birth.

  6. Maternal and obstetrical factors associated with a successful trial of vaginal birth after cesarean section

    Science.gov (United States)

    Abdelazim, Ibrahim A.; Elbiaa, Assem A. M.; Al-Kadi, Mohamed; Yehia, Amr H.; Sami Nusair, Bassam M.; Faza, Mohannad Abu

    2014-01-01

    Objective To detect the maternal and obstetrical factors associated with successful trial of vaginal birth among women with a previous cesarean delivery. Material and Methods A total of 122 women who were eligible for a trial of labor after cesarean section (TOLAC) according to departmental protocol were included in this comparative prospective study. After informed consent, the women included in this study were subjected to a thorough history to detect maternal and obstetric characteristics and a standard examination to estimate fetal weight, engagement of the fetal head, intra-partum features of fetal membranes, and cervical dilatation. After delivery, data on duration of labor, labor augmentation, mode of delivery, birth outcome, and neonatal intensive care (NICU) admission were recorded and analyzed. Results Trial of labor after cesarean section was successful in 72.13% and was unsuccessful in 27.87%. Body mass index (BMI) was significantly lower in the successful TOLAC group compared to the unsuccessful group (23.8±0.03 versus 26.2±0.02 kg/m2), and the number of women with BMI >25 kg/m2 was significantly high in the unsuccessful group; also, mean gestational age was significantly lower in the successful TOLAC group compared to the unsuccessful group (37.5±0.04 versus 38.5±0.03 weeks), and the number of women admitted in labor with gestation ≥40 weeks was significantly high in the unsuccessful group. The number of women admitted with >2/5 of fetal head palpable abdominally and fetal head station ≥-2 was significantly high in the unsuccessful TOLAC group. Conclusion In carefully selected cases, TOLAC is safe and often successful. Presence of BMI >25 kg/m2, gestation ≥40 weeks, and vertex station ≥-2 were risk factors for unsuccessful TOLAC. PMID:25584035

  7. The Outcome Analysis of Cesarean Section Cases in One-Year Period

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    Osman Balcı

    2007-04-01

    CONCLUSIONS: The rates of cesarean deliveries are increasing day by day. The increased rates of prior cesarean deliveries is a critical factor for the risks of recurrent surgeries and cost-effectiveness. We concluded that to determine the real indications for primary cesarean deliveries and to be more selective and careful are assumed to decrease the cesarean delivery rates.

  8. Early versus Late Admission to Labor Affects Labor Progression and Risk of Cesarean Section in Nulliparous Women.

    Science.gov (United States)

    Mikolajczyk, Rafael T; Zhang, Jun; Grewal, Jagteshwar; Chan, Linda C; Petersen, Antje; Gross, Mechthild M

    2016-01-01

    Rates of cesarean section increase worldwide, and the components of this increase are partially unknown. A strong role is prescribed to dystocia, and at the same time, the diagnosis of dystocia is highly subjective. Previous studies indicated that risk of cesarean is higher when women are admitted to the hospital early in the labor. We examined data on 1,202 nulliparous women with singleton, vertex pregnancies and spontaneous labor onset. We selected three groups based on cervical dilatation at admission: early (0.5-1.5 cm, N = 178), intermediate (2.5-3.5 cm, N = 320), and late (4.5-5.5 cm, N = 175). The Kaplan-Meier estimator was used to analyze the risk of delivery by cesarean section at a given dilatation, and thin-plate spline regression with a binary outcome (R library gam) to assess the form of the associations between the cesarean section in either the first or second stage versus vaginal delivery and dilatation at admission. Women who were admitted to labor early had a higher risk of delivery by cesarean section (18 versus 4% in the late admission group), while the risk of instrumental delivery did not differ (24 versus 24%). Before 4 cm dilatation, the earlier a woman was admitted to labor, the higher was her risk of delivery by cesarean section. After 4 cm dilatation, however, the relationship disappeared. These patterns were true for both first and second stage cesarean deliveries. Oxytocin use was associated with a higher risk of cesarean section only in the middle group (2.5-3.5 cm dilatation at admission). Early admission to labor was associated with a significantly higher risk of delivery by cesarean section during the first and second stages. Differential effects of oxytocin augmentation depending on dilation at admission may suggest that admission at the early stage of labor is an indicator rather than a risk factor itself, but admission at the intermediate stage (2.5-3.5 cm) becomes a risk factor itself. Further research is

  9. Effects of exercise and Kinesio taping on abdominal recovery in women with cesarean section: a pilot randomized controlled trial.

    Science.gov (United States)

    Gürşen, Ceren; İnanoğlu, Deniz; Kaya, Serap; Akbayrak, Türkan; Baltacı, Gül

    2016-03-01

    Abdominal muscle strength decreases and fat ratio in the waist region increases following cesarean section. Kinesio taping (KT) is an easily applicable method and stimulates muscle activation. The aim of this pilot randomized controlled trial (RCT) was to investigate the effects of KT combined with exercise in women with cesarean section on abdominal recovery compared to the exercise alone. Twenty-four women in between the fourth and sixth postnatal months who had cesarean section were randomly assigned to KT + exercise (n = 12) group or exercise group (n = 12). KT was applied twice a week for 4 weeks on rectus abdominis, oblique abdominal muscles and cesarean incision. All women were instructed to carry out posterior pelvic tilt, core stabilization and abdominal correction exercises. Outcome measures were evaluated with the manual muscle test, sit-up test, abdominal endurance test, Visual Analog Scale (VAS), circumference measurements and Roland Morris Disability Questionnaire (RMDQ). Mann-Whitney U and Wilcoxon tests were used to analyze data. p muscle, sit-up test, VAS, measurements of the waist circumference and RMDQ (p abdominal exercises in the postnatal physiotherapy program provides greater benefit for the abdominal recovery in women with cesarean section. Further studies with larger sample sizes and long-term follow-up are needed to verify these results.

  10. [Relationship between the risk of emergency cesarean section for nullipara with the prepregnancy body mass index or gestational weight gain].

    Science.gov (United States)

    Zhao, R F; Zhang, W Y; Zhou, L

    2017-11-25

    Objective: To investigate the risk of emergency cesarean section during labor with the pre-pregnancy body mass index or gestational weight gain. Methods: A total of 6 908 healthy nullipara with singleton pregnancy and cephalic presentation who was in term labor in Beijing Obstetrics and Gynecology Hospital from August 1(st), 2014 to September 30(th), 2015 were recruited. They were divided into two groups, the vaginal delivery group (92.88%, 6 416/6 908) and the emergency cesarean section group (7.12%, 492/6 908). According to WHO body mass index (BMI) classification criteria and the pre-pregnancy BMI, the 6 908 women were divided into three groups, the underweight group(BMIcesarean section were calculated by bivariate logistic regression. Results: (1) Comparing to the vaginal delivery group, women in the emergency cesarean section group were older, with a lower education level. Their prepregnancy BMI was higer and had more gestational weight gain. They had higher morbidity of pregnancy induced hypertension and gestational diabetes mellitus. Comparing to the vaginal delivery group, the neonates in the emergency cesarean section group were elder in gestational week, with higher birth weight. More male infants and large for gestation age infants were seen in the emergency cesarean section group (all P cesarean section for nullipara, with the unadjusted OR of 1.98 (95% CI : 1.54-2.54), adjusted OR ( aOR ) of 1.66 (95% CI : 1.27-2.16). In the inadequate GWG group and the excessive GWG group, overweight and obese women had increased risk of emergency cesarean section, with adjusted OR of 2.33 (95% CI : 1.06-5.14) and 1.62 (95% CI : 1.44-2.28), respectively. In the appropriate GWG group, there was no significant difference in the risk of emergency cesarean section between the overweight and obese women and the normal weight women, with a OR of 1.54 (95% CI : 0.94-2.54). The underweight group was associated with decreased risk of emergency cesarean section ( OR= 0.55, 95

  11. Invasive Obstetric Procedures and Cesarean Sections in Women With Known Herpes Simplex Virus Status During Pregnancy.

    Science.gov (United States)

    Stankiewicz Karita, Helen C; Moss, Nicholas J; Laschansky, Ellen; Drolette, Linda; Magaret, Amalia S; Selke, Stacey; Gardella, Carolyn; Wald, Anna

    2017-01-01

    Neonatal herpes is a potentially devastating infection that results from acquisition of herpes simplex virus (HSV) type 1 or 2 from the maternal genital tract at the time of vaginal delivery. Current guidelines recommend (1) cesarean delivery if maternal genital HSV lesions are present at the time of labor and (2) antiviral suppressive therapy for women with known genital herpes to decrease HSV shedding from the genital tract at the time of vaginal delivery. However, most neonatal infections occur in infants born to women without a history of genital HSV, making current prevention efforts ineffective for this group. Although routine serologic HSV testing of women during pregnancy could identify women at higher risk of intrapartum viral shedding, it is uncertain how this knowledge might impact intrapartum management, and a potential concern is a higher rate of cesarean sections among women known to be HSV-2 seropositive. To assess the effects of prenatal HSV-2 antibody testing, history of genital herpes, and use of suppressive antiviral medication on the intrapartum management of women, we investigated the frequency of invasive obstetric procedures and cesarean deliveries. We conducted a retrospective cohort study of pregnant women delivering at the University of Washington Medical center in Seattle, Washington. We defined the exposure of interest as HSV-2 antibody positivity or known history of genital herpes noted in prenatal records. The primary outcome was intrapartum procedures including fetal scalp electrode, artificial rupture of membranes, intrauterine pressure catheter, or operative vaginal delivery (vacuum or forceps). The secondary outcome was incidence of cesarean birth. Univariate and multivariable logistic regressions were performed. From a total of 449 women included in the analysis, 97 (21.6%) were HSV-2 seropositive or had a history of genital herpes (HSV-2/GH). Herpes simplex virus-2/GH women not using suppressive antiviral therapy were less likely

  12. Postmortem cesarean section with infant survival: a case report of an HIV-infected patient.

    Science.gov (United States)

    Esposito, M A; DeLony, R; Goldstein, P J

    1997-10-01

    Postmortem cesarean sections are rare events, but modern technology is forcing society to explore the definition of viability and the legal rights of both mother and fetus that ultimately will affect the frequency and use of this rare operation. Since the Human Immunodeficiency Virus (HIV) prevalence rate and the number of critically ill obstetrical patients with Acquired Immunodeficiency Syndrome (AIDS) continues to rise, it is reasonable to assume more patients and physicians may be confronted by issues concerning fetal and maternal rights and other considerations in perimortem delivery. A 33-year-old woman, at 27 weeks' gestation, with fulminant AIDS was admitted to the intensive care unit (ICU) in respiratory distress. As her condition deteriorated the complex problem of caring for both mother and fetus emerged. A patient advisory panel explored the issues with the patient, her family, and her health care team. Eventually a peri/postmortem cesarean section was performed on the mother when she suffered an acute fatal cardiorespiratory arrest. With the prevalence of AIDS increasing and with most women not being tested prior to pregnancy, many obstetricians will be confronted with new medical and legal challenges. Establishing comprehensive medical management for the critically ill obstetrical patient and understanding the legal rights of both patients (mother and fetus) will help avoid conflicts and potentially improve survival.

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

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    Alipour M

    2013-10-01

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

  14. Does manual removal of the placenta affect operative blood loss during cesarean section?

    Science.gov (United States)

    Gol, Mert; Baloglu, Ali; Aydin, Cetin; Ova, Leylant; Yensel, Umur; Karci, Levent

    2004-01-15

    To investigate whether manual removal of the placenta is associated with significantly more blood loss compared to spontaneous separation of the placenta during cesarean section. This was a randomised study of 200 women with normal pregnancies undergoing cesarean section. Patients were randomly assigned to the study group, manual removal (n=100) or the control group, spontaneous separation (n=100). Operative blood loss was measured using a volume and gravimetric method. Patients postoperative complications were recorded and hemoglobin levels measured at 24 and 48 h. The amount of blood loss associated with spontaneous and manual removal of the placenta was 626+/-253 ml and 589+/-272 ml, respectively. This difference was not significant. There was a decrease in the postoperative hemoglobin levels in both groups which was not significantly different. The incidence of endometritis, wound infection, and the need for blood transfusion was similar in the two groups. Manual delivery of the placenta is not associated with a significantly greater risk of operative blood loss, decreased postoperative hemoglobin levels or increased incidence of endometritis compared with spontaneous placental separation.

  15. Differential analgesic effect of tenoxicam on the wound pain and uterine cramping pain after cesarean section.

    Science.gov (United States)

    Hsu, Hsing-Wen; Cheng, Ya-Jung; Chen, Li-Kuei; Wang, Yong-Ping; Lin, Chen-Jung; Lee, Chien-Nan; Sun, Wei-Zen

    2003-01-01

    Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to enhance opioid analgesia in the acute pain service. The question, however, of whether NSAIDs produce a similar extent of potentiation among different types of pain, has not been thoroughly investigated. A randomized, placebo-controlled, double-blind study was performed to characterize the analgesic effect of tenoxicam, a long-acting NSAID, on resting wound pain, evoked wound pain, and uterine cramping pain after cesarean section. Saline (n = 48) or 20 mg tenoxicam (n = 45) was intravenously injected immediately after clamping the umbilical cord. All patients were instructed to obtain maximal postoperative analgesia by intravenous patient-controlled morphine. RESULTS Tenoxicam profoundly reduced the intensity of uterine cramping pain (3.6 [2.0-5.6] versus 5.5 [3.4-6.6]; p pain at rest, with movement, changing position, sitting, and walking. Intraoperative injection of 20 mg tenoxicam decreased the demand ratio for patient-controlled analgesia (PCA) and 24-hour morphine consumption by approximately 30%. The data show that tenoxicam potentiates opioid analgesic effect on the somatic and visceral types of pain to different extents, and they suggest that intraoperative injection of 20 mg tenoxicam is sufficient to enhance intravenous PCA morphine on uterine cramping pain for the first 24 hours after cesarean section.

  16. Inequities in milk-based prelacteal feedings in Latin America and the Caribbean: the role of cesarean section delivery.

    Science.gov (United States)

    Boccolini, Cristiano Siqueira; Pérez-Escamilla, Rafael; Giugliani, Elsa Regina Justo; Boccolini, Patricia de Moraes Mello

    2015-02-01

    Prelacteal feeds (ie, foods other than breast milk offered before the milk comes in) have been identified as a risk factor for shorter breastfeeding duration and neonatal mortality. This study aimed to test for socioeconomic inequities on the risk of milk-based prelacteal feeding associated with cesarean section delivery. We conducted secondary cross-sectional data analyses of 7 Demographic and Health Surveys conducted in Latin American and Caribbean countries between 2005 and 2010 (N = 49 253 women with children younger than 3 years of age). Multivariate logistic regression was used to test the association between cesarean section delivery and the risk of milk-based prelacteal feeding in the total samples as well as within the lowest and highest wealth quintile subsamples by country and in the pooled sample. Almost one-third of newborns received milk-based (22.9%) prelacteal feeds. Prelacteal feeding prevalence varied from 17.6% in Guiana to 55% in Dominican Republic. Cesarean section delivery was associated with significantly higher odds of introduction of milk-based prelacteals in all countries (adjusted odds ratio [AOR] range, 2.34 in Bolivia to 4.50 in Peru). The association between cesarean section delivery and risk of milk-based prelacteal feeds was stronger among the poorest than wealthiest women (AOR [95% confidence interval], 2.94 [2.58-3.67] vs 2.17 [1.85-2.54]). Women of lower socioeconomic status may need additional breastfeeding support after cesarean section delivery to prevent the introduction of milk-based prelacteals. Reducing the rates of cesarean section deliveries is likely to reduce the prevalence of prelacteal feeding. © The Author(s) 2014.

  17. The Cesarean Decision Survey

    Science.gov (United States)

    Puia, Denise M.

    2013-01-01

    A descriptive study design was used to describe the decision of women having a cesarean surgery. The Cesarean Birth Decision Survey was used to collect data from 101 postpartum women who underwent a cesarean. Most of the surgeries were to primipara women who reported doctor recommendation and increased safety for the baby as the main reasons for the cesarean. Those women who had repeat cesarean surgery all cited their previous cesarean as the main reason for the current surgery. Women’s knowledge of cesarean surgery needs to be assessed early in pregnancy so that appropriate education may be provided. Accurate and ongoing information may decrease the number of women choosing a cesarean surgery. PMID:24868134

  18. Obstetricians' perspective towards cesarean section delivery based on professional level: experience from Egypt.

    Science.gov (United States)

    Shaaban, Mohamed M; Sayed Ahmed, Waleed Ali; Ahmed, Waleed S; Khadr, Zeinab; El-Sayed, Hesham F

    2012-08-01

    (1) To investigate Egyptian obstetricians' views towards cesarean delivery on maternal request, (2) to investigate Egyptian obstetricians' views towards some of the "potentially neglected" or controversial obstetrical skills or maneuvers as external cephalic version (ECV), fetal scalp pH measurement or tubal ligation during CS and (3) to examine the effect of professional level on the above factors. This is a descriptive study performed at the 8th annual Obstetrics and Gynecology conference of Suez Canal University held at Ismailia city in Egypt in June 2011 via a structured self administered questionnaire. Questionnaire was distributed to 223 conference attendants from the three professional levels (consultants, specialists and registrars) working at the two major institutions in Egypt: University and Ministry of Health. The structured questionnaire was based on informed opinion and professional guidelines. In total, 167 (75%) completed the questionnaire. Cesarean delivery on maternal request was accepted by 66% of the studied group and acceptance was significantly higher among consultants. There was no difference in all physicians' practices of cesarean section in both private and public settings. Limited access to medical equipment such as cardiotocogram (CTG) was shown in consultant group reflecting improper private sector preparations. The study revealed that 59% of obstetricians accepted vaginal breech delivery, and only 14% would consider ECV. Fetal scalp pH taking in cases of abnormal CTG was accepted by only 16.3% and 49% rejected the practice of instrumental delivery. There were significant differences among the three professional and the two institutional groups regarding these attitudes. There were different views regarding tubal sterilization during CS. Lack of knowledge, the need to improve some clinical skills and some professional attitudes may shed light on rising CS rates in Egypt.

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

    DEFF Research Database (Denmark)

    Bergholt, Thomas; Østberg, Birgitte; Legarth, Jesper

    2004-01-01

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

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

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    Maryam Nikpour

    2014-07-01

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

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

    Directory of Open Access Journals (Sweden)

    Ânderson Gonçalves Sampaio

    2010-04-01

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

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

    Science.gov (United States)

    Pyykönen, Aura; Gissler, Mika; Løkkegaard, Ellen; Bergholt, Thomas; Rasmussen, Steen C; Smárason, Alexander; Bjarnadóttir, Ragnheiður I; Másdóttir, Birna B; Källén, Karin; Klungsoyr, Kari; Albrechtsen, Susanne; Skjeldestad, Finn E; Tapper, Anna-Maija

    2017-05-01

    The cesarean rates are low but increasing in most Nordic countries. Using the Robson classification, we analyzed which obstetric groups have contributed to the changes in the cesarean rates. Retrospective population-based registry study including all deliveries (3 398 586) between 2000 and 2011 in Denmark, Finland, Iceland, Norway and Sweden. The Robson group distribution, cesarean rate and contribution of each Robson group were analyzed nationally for four 3-year time periods. For each country, we analyzed which groups contributed to the change in the total cesarean rate. Between the first and the last time period studied, the total cesarean rates increased in Denmark (16.4 to 20.7%), Norway (14.4 to 16.5%) and Sweden (15.5 to 17.1%), but towards the end of our study, the cesarean rates stabilized or even decreased. The increase was explained mainly by increases in the absolute contribution from R5 (women with previous cesarean) and R2a (induced labor on nulliparous). In Finland, the cesarean rate decreased slightly (16.5 to 16.2%) mainly due to decrease among R5 and R6-R7 (breech presentation, nulliparous/multiparous). In Iceland, the cesarean rate decreased in all parturient groups (17.6 to 15.3%), most essentially among nulliparous women despite the increased induction rates. The increased total cesarean rates in the Nordic countries are explained by increased cesarean rates among nulliparous women, and by an increased percentage of women with previous cesarean. Meanwhile, induction rates on nulliparous increased significantly, but the impact on the total cesarean rate was unclear. The Robson classification facilitates benchmarking and targeting efforts for lowering the cesarean rates. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  3. Delayed Neuraxial Hematoma in Parturient With Fontan Circulation Following Neuraxial Anesthesia for Cesarean Section.

    Science.gov (United States)

    Chiaghana, Chukwudi O; Bremer, Justin M; Sappenfield, Joshua W; Wendling, Adam L

    Neuraxial hematoma is a rare complication of spinal or epidural anesthesia. However, variable coagulation factor defects are relatively common in patients with Fontan circulation, and may predispose such patients to either increased risk of thrombosis or coagulopathy. These defects may indirectly increase their risk of neuraxial hematoma. We report a case of delayed neuraxial hematoma after the start of full-dose anticoagulation for pulmonary embolus on a postpartum patient with Fontan physiology who had continuous spinal anesthesia for cesarean delivery 4 days earlier. Parturients with single ventricle physiology present numerous challenges to balance, including pregnancy-related physiologic alterations in blood volume, cardiac output, systemic vascular resistance, oxygen consumption, and coagulation. Although neuraxial anesthesia is common in this population, it is not without risks. We report the circumstances surrounding a parturient with single ventricle physiology who experienced neuraxial hematoma 4 days after continuous spinal anesthesia despite adherence to accepted guidelines. Eighteen months after undergoing a cesarean section, she had a full recovery and returned to her baseline medical status.

  4. Anesthetic management of cesarean section in cases of placenta accreta, with versus without abdominal aortic balloon occlusion: study protocol for a randomized controlled trial.

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    Chu, Qinjun; Shen, Dan; He, Long; Wang, Hongwei; Zhao, Xianlan; Chen, Zhimin; Wang, Yanli; Zhang, Wei

    2017-05-26

    Placenta accreta (PA), a severe complication during delivery, is closely linked with massive hemorrhage which could endanger the lives of both mother and baby. Moreover, the incidence of PA has increased dramatically with the increasing rate of cesarean deliveries in the past few decades. Therefore, studies evaluating the effects of different perioperative managements based on different modalities in the treatment of PA are necessary. Among the numerous treatment measures, prophylactic abdominal aortic balloon occlusion (AABO) in combination with cesarean section for PA seems to be more advantageous than others. However, up to now, all studies on AABO were almost retrospective. Current evidence is insufficient to recommend for or against routinely using the AABO technology for control intraoperative hemorrhage in patients with PA. Thus, we hope to carry out a prospective, randomized controlled trial (RCT) study to confirm the effectiveness of the AABO technology in patients with PA. This trial is an investigator-initiated, prospective RCT that will test the superiority of AABO in combination with cesarean section compared to the traditional hysterectomy following cesarean section for parturients with PA. A total of 170 parturients with PA undergoing cesarean section will be randomized to receive either AABO in combination with cesarean section or the traditional hysterectomy following cesarean section. The primary outcome is estimated blood loss. The most important secondary outcome is the occurrence of cesarean hysterectomy during delivery; others include blood transfusion volume, operating time, neonate's Apgar scores (collected at 1, 5 and 10 min), length of stay in intensive care unit, total hospital stay, and balloon occlusion-relative data. This prospective trial will test the superiority of AABO in combination with cesarean section compared to the traditional hysterectomy following cesarean section for parturients with PA. It may provide strong evidence

  5. Efficacy of intravenous tramadol and low-dose ketamine in the prevention of post-spinal anesthesia shivering following cesarean section: a double-blinded, randomized control trial.

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    Lema, Girmay Fitiwi; Gebremedhn, Endale Gebreegziabher; Gebregzi, Amare Hailekiros; Desta, Yilkal Tadesse; Kassa, Adugna Aregawi

    2017-01-01

    Shivering is a frequent and undesirable complication of spinal anesthesia. It is a physiologic response to increase the body core temperature in an attempt to raise metabolic heat production. However, shivering may trigger myocardial ischemia; increase intraocular and intracranial pressures, increase wound pain, delay wound healing and interfere with pulse rate, blood pressure and electrocardiogram monitoring. We aimed to compare the efficacy of intravenous (IV) ketamine with IV tramadol for the prevention of shivering in patients who underwent cesarean delivery under spinal anesthesia. A prospective, randomized, double-blind study was conducted. One hundred and twenty-three American Society of Anesthesiologist I and II patients, aged between 18 and 39 years, who underwent cesarean section were included in the study. Patients were randomly allocated to one of three groups: group S (n=41; control group) received saline, group K (n=41) received ketamine 0.2 mg/kg and group T (n=41) received tramadol 0.5 mg/kg. Incidence and grade of shivering and side effects between the treatment groups were recorded. The incidence of shivering was significantly reduced in the ketamine and tramadol groups (41.5% and 53.7%, respectively) compared to the saline group (70.7%; p =0.028). Grade 3 shivering occurred in 16 (39%) patients in the saline group, compared to 9 (22%) in the tramadol group and 8 (19.5%) in the ketamine group ( p =0.011). Only two cases in the saline group developed grade 4 shivering ( p shivering. We recommend low-dose IV ketamine or tramadol prophylaxis for parturients undergoing cesarean section under spinal anesthesia.

  6. Cesarean section rate in Iran, multidimensional approaches for behavioral change of providers: a qualitative study

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    Rashidian Arash

    2011-07-01

    Full Text Available Abstract Background The cesarean section rate has been steadily rising from 35% in 2000 to 40% in 2005 in Iran. The objective of this study was to identify barriers of reduce the cesarean section rate in Iran, as perceived by obstetricians and midwives as the main behavioral change target groups. Methods A qualitative study with purposive sampling was designed in which data were collected through in-depth interviews and document analyses. Hospitals were selected on the bases of being public and or private and their response to the ministry's C-section reduction interventions. The hospital director, obstetricians and midwives from each hospital were included in the study. The classification of barriers suggested by Grol and Wensing was used for the thematic analysis. Results After 26 in-depth interviews and document analyses, the barriers were identified as: financial, insurance and judicial problems at the economic and political context level; the type and ownership of hospitals, absence of an on call physician, absence of clear job-descriptions for obstetricians and midwives, too many interventions in the delivery process and shortage of human resources and facilities at the organizational context level; distrust and insufficient collaborations between obstetricians and midwives from macro to micro level at the social context level; attitudes toward complications of C-section, reduced capabilities of obstetricians, midwives and residents at the individual professional level; and finally, at the innovation level, vaginal delivery is time consuming, imposes high stress levels and is unpredictable. Conclusion Changing service providers' behavior is not possible through presentation of scientific evidence alone. A multi-level and multidisciplinary approach using behavior change theories is unavoidable. In future studies, the effect of the barriers should be determined to help policy makers recognize the most effective interventional package.

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

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    Royo Pedro

    2009-01-01

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

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

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    Ibrahima Farikou

    2014-01-01

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

  9. Intrathecal Fentanyl Lidocaine combination for cesarean section: a randomized clinical trial

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    Raji B

    2007-09-01

    Full Text Available Background: Spinal anesthesia can be associated with hemodynamic changes and some other complications. The aim of this study was to evaluate the effect of adding fentanyl to lidocaine on the spinal anesthesia time and its complications for cesarean section.Methods: Sixty pregnant women with gestational age of 37- 42 weeks and ASA physical status I and II undergoing elective cesarean section under spinal anesthesia were enrolled in a randomized double blinded clinical trial. They were randomly allocated to receive spinal anesthesia with lidocaine-normal saline (LS: 75 mg lidocaine 5% with 0.3 ml normal saline lidocaine-fentanyl (LF group (75 mg lidocaine 5% with 50 μg fentanyl. The duration of initiation of sensory block to achieve T4 level, time to return of sensory level to T12, time to first analgesic request, ephedrine requirement, nausea and vomiting during and after the surgery, pruritus, respirator depression, headache and apgar score of the new born  at 1st and 5th minutes were assessed. Results: There was no significant difference between time to achieve T4 level, ephedrine dose, post operative nausea and vomiting (PONV, pruritus and headache in study groups. Time to return of sensory level to T12 was significantly longer in LF group (152.6±14.7 vs. 66.2±11.2 min, P=0.0009. Time to first analgesic request was also longer in LF group (164.2±20.8 vs. 68.1±11.3 min, P=0.0009. The incidence of nausea and vomiting during surgery was significantly more in LF group (20% vs. 0%, P=0.023. No case of respiratory depression was observed in groups. The 1st and 5th minute's apgar score were comparable between groups and were between 7 and 10.Conclusions: Addition of fentanyl to intrathecal lidocaine in patients undergoing elective cesarean section results in increasing of the block duration and time to first analgesic request without significant maternal or neonatal side-effects, without effect on 1st and 5th minutes apgar score

  10. Anesthetic management for cesarean section in a patient with uncorrected double-outlet right ventricle.

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    Gu, Juan; Cai, Yunxia; Liu, Bin; Lv, Sheng

    2016-01-01

    We describe the anesthetic management for cesarean section in a pregnant woman with uncorrected double-outlet right ventricle. The anesthetic method, treatment of complications and lessons are discussed. A 28-year-old woman visited our emergency room for progressive dyspnea and recurrent hemoptysis at 30 weeks' gestation. Her New York Heart Association functional class was III-IV. Echocardiography indicated that she had congenital heart disease of double-outlet right ventricle. She hadn't received any treatment. The obstetrician decided to terminate the pregnancy by cesarean section. We chose epidural anesthesia and pumped phenylephrine at the same time to minimize hemodynamic fluctuation. Just in the process of changing position to supine position with uterus displaced to the left, the patient coughed badly and complained about dyspnea. At the same time, the oxygen saturation decreased quickly. The symptoms were ameliorated soon by treating as heart failure. But the symptoms reappeared after oxytocin administration. At the end of surgery, the baby was sent to the Neonatal Intensive Care Unit for premature birth. The mother recovered successfully and discharged 7 days later. Double-outlet right ventricle is a seldom disease and pregnancy with uncorrected double-outlet right ventricle is rare. In this case, the patient belonged to the type of ventricular septal defect characterized by subaortic ventricular septal defect without pulmonary stenosis. Most of the aorta arises from the right ventricle, the volume of venous blood was injected from the right ventricle into the aorta, which decided the oxygen saturations. Compared to general anesthesia, epidural anesthesia reduces venous return and alleviates the cardiac burden. So, we pumped phenylephrine along with epidural anesthesia in case of critical cyanosis following significant blood pressure decrease. In the process of anesthesia, dyspnea, cough and cyanosis attacked the patient for two times. The most

  11. Synergistic effect of intrathecal fentanyl and bupivacaine in spinal anesthesia for cesarean section

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    Srivastava Pratima

    2005-05-01

    Full Text Available Abstract Background Potentiating the effect of intrathecal local anesthetics by addition of intrathecal opiods for intra-abdominal surgeries is known. In this study by addition of fentanyl we tried to minimize the dose of bupivacaine, thereby reducing the side effects caused by higher doses of intrathecal bupivacaine in cesarean section. Methods Study was performed on 120 cesarean section parturients divided into six groups, identified as B8, B10 and B 12.5 8.10 and 12.5 mg of bupivacaine mg and FB8, FB10 and FB 12.5 received a combination of 12.5 μg intrathecal fentanyl respectively. The parameters taken into consideration were visceral pain, hemodynamic stability, intraoperative sedation, intraoperative and postoperative shivering, and postoperative pain. Results Onset of sensory block to T6 occurred faster with increasing bupivacaine doses in bupivacaine only groups and bupivacaine -fentanyl combination groups. Alone lower concentrations of bupivacaine could not complete removed the visceral pain. Blood pressure declined with the increasing concentration of Bupivacaine and Fentanyl. Incidence of nausea and shivering reduces significantly whereas, the postoperative pain relief and hemodynamics increased by adding fentanyl. Pruritis, maternal respiratory depression and changes in Apgar score of babies do not occur with fentanyl. Conclusion Spinal anesthesia among the neuraxial blocks in obstetric patients needs strict dose calculations because minimal dose changes, complications and side effects arise, providing impetus for this study. Here the synergistic, potentiating effect of fentanyl (an opiod on bupivacaine (a local anesthetic in spinal anesthesia for cesarian section is presented, fentanyl is able to reduce the dose of bupivacaine and therefore its harmful effects.

  12. Public release of institutional Cesarean section rates in South Korea: which women were aware of the information?

    Science.gov (United States)

    Khang, Young-Ho; Yun, Sung-Cheol; Jo, Min-Woo; Lee, Moo-Song; Lee, Sang-Il

    2008-04-01

    Public media reports of institutional Cesarean section rates have been used as a tool to reduce unnecessary surgical births. We examined women's awareness of the public release of this information according to socio-demographic characteristics in South Korea. The public release of institutional Cesarean section rates occurred on July 7, 2000. Seven months later, from February 7 to 14, 2001, we conducted a cross-sectional telephone survey of South Korean women aged 20-49 years (N=505, response rate=57.3%) with a nationwide sample using a proportionate quota and systematic random sampling method. A total of 228 women (45.1% of 505) were aware of the public release of Cesarean section rates 7 months before. The awareness level differed by age and parity. After adjusting for age and parity, the awareness level was patterned by women's educational attainment and income. Women with low socioeconomic status held a lower awareness level compared with their counterparts. Level of respondent's interest in health related information was significantly associated with awareness of public release. Socioeconomic differentials in awareness were partly explained by the level of respondent's interest in health related information. Policy efforts to increase awareness of public media reports on institutional Cesarean section rates among disadvantaged women are needed.

  13. Cesarean section trends in the Nordic Countries – a comparative analysis with the Robson classification

    DEFF Research Database (Denmark)

    Pyykönen, Aura; Gissler, Mika; Løkkegaard, Ellen

    2017-01-01

    Introduction: The cesarean rates are low but increasing in most Nordic countries. Using the Robson classification, we analyzed which obstetric groups have contributed to the changes in the cesarean rates. Material and methods: Retrospective population-based registry study including all deliveries...... (3 398 586) between 2000 and 2011 in Denmark, Finland, Iceland, Norway and Sweden. The Robson group distribution, cesarean rate and contribution of each Robson group were analyzed nationally for four 3-year time periods. For each country, we analyzed which groups contributed to the change...... in the total cesarean rate. Results: Between the first and the last time period studied, the total cesarean rates increased in Denmark (16.4 to 20.7%), Norway (14.4 to 16.5%) and Sweden (15.5 to 17.1%), but towards the end of our study, the cesarean rates stabilized or even decreased. The increase...

  14. Effects of intrathecal dexmedetomidine on shivering after spinal anesthesia for cesarean section: a double-blind randomized clinical trial.

    Science.gov (United States)

    Nasseri, Karim; Ghadami, Negin; Nouri, Bijan

    2017-01-01

    Shivering is among the common troublesome complications of spinal anesthesia (SA), and causes discomfort and discontentment in parturients undergoing cesarean sections (CSs). The aim of this study was to investigate the effects of intrathecal dexmedetomidine in the prevention of shivering in those who underwent CS under SA. Fifty parturients planned for elective CSs under SA were enrolled in this prospective, double-blinded, controlled study and randomly divided into two equal groups. Spinal block was achieved with 12.5 mg 0.5% heavy bupivacaine plus 5 μg dexmedetomidine (BD group) or 0.5 mL 0.9% normal saline (BN group). The incidence and intensity of shivering, peripheral and core body temperature, hemodynamic parameters, and adverse events was recorded. The incidence of shivering was significantly higher in the BN group (52%) than the BD group (24%) ( P =0.04). Likewise, the intensity of shivering was significantly higher in the BN group than the BD group ( P =0.04). The incidence of adverse events, such as hypotension, nausea/vomiting, and bradycardia, was not significantly different between the two groups, although the grade of sedation was higher in the BD group than the BN group ( P =0.004). We conclude that intrathecal dexmedetomidine is effective in lowering the incidence and intensity of shivering in parturients undergoing CSs under SA without major adverse effects.

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

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    Subrata Podder

    2015-01-01

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

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

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    Ljuština Saša

    2013-01-01

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

  17. Changing trends in the management of hypotension following spinal anesthesia in cesarean section

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    J K Mitra

    2013-01-01

    Full Text Available Hypotension during cesarean section under spinal anesthesia remains a frequent scenario in obstetric practice. A number of factors play a role in altering the incidence and severity of hypotension. Counteracting aortocaval compression does not significantly prevent hypotension in most singleton pregnancies. Intravenous crystalloid pre-hydration is not very efficient. Thus, the focus has changed toward co-hydration and use of colloids. Among vasopressors, phenylephrine is now established as a first line drug, although there is limited data in high-risk patients. Though ephedrine crosses the placenta more than phenylephrine and can possibly cause alterations in the fetal physiology, it has not been shown to affect the fetal Apgar or neurobehavioral scores.

  18. Effect of Maternal Obesity on Maternal-Fetal Transfer of Preoperative Cefazolin at Cesarean Section.

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    Groff, Stephanie McKenney; Fallatah, Wareef; Yang, Samuel; Murphy, Jamie; Crutchfield, Christopher; Marzinke, Mark; Kurtzberg, Joanne; Lee, Carlton K K; Burd, Irina; Farzin, Azadeh

    2017-01-01

    American Congress of Obstetricians and Gynecologists recommends a single dose of antibiotic prophylaxis before all cesarean sections (C/S). This recommendation is based on pharmacokinetic studies that include only non-obese patients. We sought to evaluate 1) cefazolin plasma concentrations among obese and non-obese patients after administration of a 2-g cefazolin dose for prevention of surgical wound infections, and 2) whether cefazolin concentration in fetal circulation may be protective against pathogens that cause early onset neonatal sepsis. Maternal and fetal cefazolin plasma concentrations were compared between obese (body mass index [BMI] ≥ 30 kg/m 2 ) and non-obese (BMI 0.05). Administration of 2 g of cefazolin to women undergoing scheduled C/S might be an adequate prophylactic dose for surgical wound infection in both non-obese and obese patients; and cefazolin concentration in fetal circulation may be protective against GBS and S aureus.

  19. Surgical site infection after cesarean section: implementing 3 changes to improve the quality of patient care.

    Science.gov (United States)

    Corcoran, Suzanne; Jackson, Valerie; Coulter-Smith, Sam; Loughrey, John; McKenna, Peter; Cafferkey, Mary

    2013-12-01

    Surgical site infection (SSI) is an important complication of cesarean section (CS) delivery and a key quality indicator of patient care. A baseline assessment was undertaken to determine SSI rates, and subsequently a quality improvement program was introduced, followed by repeat surveillance. Data were collected during in-hospital stays and for up to 30 days after CS during both periods. Interventions in the quality improvement program included the use of nonabsorbable sutures for skin closure, use of clippers instead of razors, and use of 2% ChloraPrep for skin disinfection before incision. A total of 710 patients were surveyed before the interventions, and 824 patients were surveyed after the interventions. Of these, 114 (16%) had an SSI before the interventions, and 40 (4.9%) had an SSI after the interventions (P Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  20. Spontaneous Fundal Uterine Rupture in a Pregnant Woman at 32 Weeks Gestation who had Two Previous Cesarean Sections

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    Metin Kaba

    2017-08-01

    Full Text Available Spontaneous uterine rupture during pregnancy can cause severe complications, even maternal and fetal demise. We report successful management of a spontaneous fundal uterine rupture in a 32 week pregnant who had undergone two previous cesarean sections due to preterm delivery. We explain causes of spontaneous uterine rupture and the management of this rare event in the presented case report.

  1. Comparison of maternal and fetal complications in elective and emergency cesarean section: a systematic review and meta-analysis.

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    Yang, Xiao-Jing; Sun, Shan-Shan

    2017-09-01

    Though the same types of complication were found in both elective cesarean section (ElCS) and emergence cesarean section (EmCS), the aim of this study is to compare the rates of maternal and fetal morbidity and mortality between ElCS and EmCS. Full-text articles involved in the maternal and fetal complications and outcomes of ElCS and EmCS were searched in multiple database. Review Manager 5.0 was adopted for meta-analysis, sensitivity analysis, and bias analysis. Funnel plots and Egger's tests were also applied with STATA 10.0 software to assess possible publication bias. Totally nine articles were included in this study. Among these articles, seven, three, and four studies were involved in the maternal complication, fetal complication, and fetal outcomes, respectively. The combined analyses showed that both rates of maternal complication and fetal complication in EmCS were higher than those in ElCS. The rates of infection, fever, UTI (urinary tract infection), wound dehiscence, DIC (disseminated intravascular coagulation), and reoperation of postpartum women with EmCS were much higher than those with ElCS. Larger infant mortality rate of EmCS was also observed. Emergency cesarean sections showed significantly more maternal and fetal complications and mortality than elective cesarean sections in this study. Certain plans should be worked out by obstetric practitioners to avoid the post-operative complications.

  2. Comparison of hydroxyethyl starch versus normal saline for epidural volume extension in combined spinal epidural anesthesia for cesarean section

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    Sunanda Gupta

    2012-01-01

    Conclusion: We conclude that an intrathecal dose of 6 mg hyperbaric bupivacaine with 25 mcg fentanyl is adequate for cesarean section when used in CSE with the EVE technique, using 0.9% saline or 6% HES. However, EVE with HES provides optimal hemodynamic profile as compared to EVE with saline.

  3. Consider the Risk of Vesicouterine Fistula in the Event of Intermittent Fluid Vaginal Discharge after a Cesarean Section

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    Pascal Talla

    2017-10-01

    Full Text Available Though the number of Vesicouterine Fistulas is steadily increasing in association with the increasing number of cesarean sections, clinical presentation can be subtle and not easily identified. In this case study, we will review the presenting symptoms of this complication and suggest an updated management protocol.

  4. Incidence of shivering after cesarean section under spinal anesthesia with or without intrathecal sufentanil: a randomized study.

    Science.gov (United States)

    de Figueiredo Locks, Giovani

    2012-01-01

    Shivering is a cause of discomfort and dissatisfaction in patients undergoing cesarean section. The objective of this study paper was to assess the impact of intrathecal administration of sufentanil on the incidence of shivering after cesarean section. In a prospective blinded, randomized clinical trial, pregnant women undergoing cesarean section under spinal anesthesia were enrolled. Pregnant women in labor, febrile, obese, with pregnancy-induced hypertension, anesthetic block failure or surgical complications were excluded. Patients were randomly assigned to two groups. In Group I, 10mg of 0.5% hyperbaric bupivacaine combined with 80 mcg of morphine and 2.5 mcg of sufentanil were administered. In Group II, 10mg of 0.5% hyperbaric bupivacaine combined with 80 mcg of morphine were administered. In the post-anesthesia care unit, patients were evaluated for signs of shivering by an investigator blinded to the patient's group allocation. The sample consisted of 80 patients. In both groups there was a decrease in axillary temperature of patients after cesarean section (pshivering in the immediate postoperative period. Copyright © 2012 Elsevier Editora Ltda. All rights reserved.

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

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    Parisa Golfam

    2016-09-01

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

  6. Prognostic factors for the success of endometrial ablation in the treatment of menorrhagia with special reference to previous cesarean section

    NARCIS (Netherlands)

    Peeters, Jos A. H.; Penninx, Josien P. M.; Mol, Ben Willem; Bongers, Marlies Y.

    2013-01-01

    To assess whether, among other prognostic factors, a history of Cesarean section is associated with endometrial ablation failure in the treatment of menorrhagia. Study design We compared women who had failed ablation to women who had successful ablation for menorrhagia in a case-control study.

  7. Cost-utility analysis of negative pressure wound therapy in high-risk cesarean section wounds.

    Science.gov (United States)

    Tuffaha, Haitham W; Gillespie, Brigid M; Chaboyer, Wendy; Gordon, Louisa G; Scuffham, Paul A

    2015-05-15

    Obese women undergoing cesarean section are at increased risk of postoperative infection. There is growing interest in negative pressure wound therapy (NPWT) to prevent closed surgical incision complications including surgical site infection; however, the evidence on the effectiveness and cost-effectiveness of this technology is limited. The objective of this study was to evaluate the cost-effectiveness of NPWT compared with that of standard dressing in preventing surgical site infection in obese women undergoing elective cesarean section based on current evidence and to estimate the value and optimal design of additional research to study this technology. The analysis was from the perspective of Queensland Health, Australia, using a decision model. Parameters were obtained from the published literature, a pilot clinical trial, and expert opinion. Monte Carlo simulation was performed to calculate the net monetary benefit, characterize decision uncertainty, and estimate the value of additional research. Comparing the expected monetary benefits and costs of alternative trial sample sizes informed the optimal future study design. The incremental net monetary benefit of NPWT was Australian dollars 70, indicating that NPWT is cost-effective compared with that of standard dressing. The probability of NPWT being cost-effective was 65%. The estimated value of additional research to resolve decision uncertainty would be Australian dollars 2.7 million. The optimal sample size of a future trial investigating the relative effectiveness of NPWT would be 200 patients per arm. Based on the current evidence, NPWT is cost-effective; however, there is high uncertainty surrounding the decision to adopt this technology. Additional research is worthwhile before implementation. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Reference Values for Umbilical Cord Blood Gases of Newborns Delivered by Elective Cesarean Section.

    Science.gov (United States)

    Manomayangkul, Kattiya; Siriussawakul, Arunotai; Nimmannit, Akarin; Yuyen, Thassayu; Ngerncham, Sopapan; Reesukumal, Kanit

    2016-05-01

    Umbilical cord blood gas values are better indicators of perinatal asphyxia than Apgar scores. Many studies have reported normal ranges of umbilical cord blood gases, which vary greatly due to many factors. This study aimed to establish the reference values of umbilical cord blood gases of normal cesarean newborns in a university hospital setting. Blood samples from the umbilical artery and vein were collected from 160 newborns delivered by elective cesarean section. The indications for caesarean section were not due to fetal distress, intrauterine growth retardation, or non-reassuring fetal heart rate. The blood samples were collected immediately after birth in the operating room and then sent for blood-gas analysis. The blood-gas values were statistically analyzed and reported. The cord blood collected from 160 newborns was analyzed in this study. Seventy-eight percent (115) of the parturients were hypotensive before delivery. All Apgar scores at one and five minutes after delivery were at least 7. The calculated reference range of the umbilical arterial pH was 7.18-7.42, of pO₂was 6.43-29.43 mmHg, of pCO₂was 33.44-66.56 mmHg, and of HCO₃was 15.60-30.70 mEq/L. The reference range obtained for the umbilical venous pH was 7.28-7.44,for pO₂was 13.97-37.13 mmHg, for pCO₂was 30.70-57.0 mmHg, and for HCO₃was 18.50-29.90 mEq/L. The study determined normal reference values as a result of umbilical cord blood gas analyses.

  9. The Effect of Epidural Analgesia Alone and in Association With Other Variables on the Risk of Cesarean Section.

    Science.gov (United States)

    Herrera-Gómez, Antonio; Luna-Bertos, Elvira De; Ramos-Torrecillas, Javier; Ocaña-Peinado, Francisco Manuel; García-Martínez, Olga; Ruiz, Concepción

    2017-07-01

    Epidural analgesia (EA) is the most widespread pharmacologic method of labor pain relief. There remains disagreement, however, regarding its adverse effects. The objective of this study was to determine the effect of EA administration on the risk of cesarean delivery and its causes (e.g., stalled labor, risk of loss of fetal well-being, among others) and the degree to which this effect may be modulated by mother-, newborn-, and labor-related variables. A retrospective cohort observational study was conducted including all deliveries in a Spanish public hospital between March 2010 and March 2013 ( N = 2,450; EA = 562, non-EA = 1,888). Risk of a cesarean section was significantly increased by EA administration (odds ratio [ OR] = 2.673; p cesarean deliveries due to the risk of loss of fetal well-being was significantly higher in the EA (47.8%) versus non-EA group (27.5%; OR = 1.739; p = 0.0012,). The EA-associated risk of cesarean section was not significantly modified as a function of maternal age or parity, fetal position, newborn weight, weeks of gestation, or sedation administration alone. However, these variables in combination may increase the risk. We present multivariate models for each group that account for these variables, allowing for estimation of the risk of a cesarean delivery if EA is administered. EA is associated with an increased risk of cesarean delivery. Other variables in combination (maternal age or parity, fetal position, newborn weight, weeks of gestation, or sedation administration) may increase this risk.

  10. Cesarean Section Delivery Is Not a Risk Factor for Development of Inflammatory Bowel Disease: A Population-based Analysis.

    Science.gov (United States)

    Bernstein, Charles N; Banerjee, Ankona; Targownik, Laura E; Singh, Harminder; Ghia, Jean Eric; Burchill, Charles; Chateau, Dan; Roos, Leslie L

    2016-01-01

    Mode of birth affects development of the intestinal microbiota, and microbial dysbiosis has been associated with inflammatory bowel disease (IBD). We performed a population-based analysis to determine whether mode of delivery (cesarean section vs. vaginal delivery) affects risk of IBD. We collected data from the University of Manitoba IBD Epidemiology Database, which contains records on all Manitobans diagnosed with IBD from 1984 through 2010. Starting in 1970, 6-digit family health registration numbers were used in Manitoba to link mothers with their offspring. Maternal health records, including dates and modes of delivery and siblings of individuals with IBD, were identified. We obtained data on 1671 individuals with IBD and 10,488 controls (individuals without IBD, matched by age, sex, and area of residence at IBD diagnosis) linked to mothers' obstetrical records. Higher proportions of urban than rural residents were delivered by cesarean section for IBD cases (12.8% vs. 9.7%, P = .05) and controls (13.3% vs. 9.4%, P cesarean section (13.5% vs. 8.4%, P = .01). Overall, there was no difference in the percentage of IBD cases born by cesarean section (11.6%) vs. controls (11.7%, P = .93). In multivariate analysis, birth by cesarean section was not associated with an increased risk of subsequent IBD, controlling for age, sex, urban residence, and income (odds ratio, 1.04; 95% confidence interval, 0.89-1.23). Persons with IBD were no more likely to have been born by cesarean section than their siblings without IBD (1740 siblings from 1615 families) (11.6% vs. 11.3%; odds ratio, 1.14; 95% confidence interval, 0.72-1.80; P = .79). People with IBD were not more likely to have been born via cesarean section than controls or siblings without IBD. These findings indicate that events of the immediate postpartum period that shape the developing intestinal microbiome do not affect risk for IBD. Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

  11. The application of uterine artery embolization for the treatment of uterine scar pregnancy after cesarean section

    International Nuclear Information System (INIS)

    Chen Yi; Xie Chunming; Yang Minling; Feng Duiping; Pang Ningdong; Cui Liping; Cui Jinxi; Liu Wenying

    2012-01-01

    Objective: To assess the clinical value of uterine arterial embolization (UAE) in treating uterine scar pregnancy after cesarean section. Methods: A total of' 35 cases with cesarean scar pregnancy, admitted to authors' hospital during the period from Jan. 2007 to June 2011, were divided into two groups: embolization group (n=21) and non-embolization group (n=14). By using Seldinger technique, UAE was performed via the right femoral access and gelatin sponge particle was used as embolization agent to occlude the uterine artery. In embolization group, sixteen patients received uterine cavity curettage one or two days after UAE, while five patients received laparotomy or perineotomy surgery to remove the lesions after UAE. In non-embolization group, uterine cavity curettage was performed directly in 8 patients, local injection of' methotrexate followed by uterine cavity curettage was carried out in 3 patients, and direct laparotomy to remove the lesions was adopted in the remaining 3 patients. The blood loss during the procedure, the hospitalization days and the time for β-HCG levels falling to normal were documented. The results were compared between the two groups. Results: UAE was successfully accomplished in all the 21 patients of embolization group and the uterus was preserved in all patients. For the embolization group, the mean hospitalization time was (11.5±3.6) days, and the time for β-HCG levels falling to normal was (18.6±4.9) days. For the non-embolization group, the mean hospitalization time was(20.4±5.2)days, and the time for β-HCG levels falling to normal was (28.7±5.6)days. Hysterectomy had to be carried out in two patients of non-embolization group due to the massive bleeding occurred in therapeutic procedures. Conclusion: For the treatment of cesarean scar pregnancy, UAE is very effective and mini-invasive with high success rate. UAE can preserve the patient's reproductive function, and it also plays a significant role in preventing hemorrhage

  12. Coping with preoperative anxiety in cesarean section: physiological, cognitive, and emotional effects of listening to favorite music.

    Science.gov (United States)

    Kushnir, Jonathan; Friedman, Ahuva; Ehrenfeld, Mally; Kushnir, Talma

    2012-06-01

    Listening to music has a stress-reducing effect in surgical procedures. The effects of listening to music immediately before a cesarean section have not been studied. The objective of this study was to assess the effects of listening to selected music while waiting for a cesarean section on emotional reactions, on cognitive appraisal of the threat of surgery, and on stress-related physiological reactions. A total of 60 healthy women waiting alone to undergo an elective cesarean section for medical reasons only were randomly assigned either to an experimental or a control group. An hour before surgery they reported mood, and threat perception. Vital signs were assessed by a nurse. The experimental group listened to preselected favorite music for 40 minutes, and the control group waited for the operation without music. At the end of this period, all participants responded to a questionnaire assessing mood and threat perception, and the nurse measured vital signs. Women who listened to music before a cesarean section had a significant increase in positive emotions and a significant decline in negative emotions and perceived threat of the situation when compared with women in the control group, who exhibited a decline in positive emotions, an increase in the perceived threat of the situation, and had no change in negative emotions. Women who listened to music also exhibited a significant reduction in systolic blood pressure compared with a significant increase in diastolic blood pressure and respiratory rate in the control group. Listening to favorite music immediately before a cesarean section may be a cost-effective, emotion-focused coping strategy. (BIRTH 39:2 June 2012). © 2012, Copyright the Authors Journal compilation © 2012, Wiley Periodicals, Inc.

  13. A randomized trial comparing skin closure in cesarean section: interrupted suture with nylon vs subcuticular suture with No '1' polyfilament.

    Science.gov (United States)

    Shrestha, A; Napit, J; Neupane, B; Sedhai, L B

    2013-09-01

    Cesarean section is one of the most commonly performed operations in most countries of the world including Nepal. Hence there is a load on the financial resources of healthcare system. The rational of this study was to utilize the remaining No '1' polyfilament after closing rectus sheath to stitch skin. So, the primary objective was to determine the wound complication rates for subcuticular suture with No'1' petcryl (polyfilamentpolyglycolic acid) Vs intermittent suture with nylon 2-0 for skin closure at cesarean delivery and secondary objective was to compare postoperative pain and patient satisfaction about the scar. One hundred and thirty eight women undergoing cesarean section at Chitwan Medical College was randomized to either intermittent skin suture with nylon 2-0 or subcuticular with polyfilament No '1' (remaining suture after closing rectus sheath). Evidence of wound infection, pain and overall satisfaction were assessed postoperatively. The overall wound complications rate in subcuticular stitch with No'1' polyfilament suture were similar as in intermittent mattress stitch with nylon 2-0 (15.9% vs. 14.49%). Pain on postoperative third day and six weeks and overall satisfaction about wound were similar in both groups. Only prolong rupture of membrane >18 hours was found to be a significant risk factor of wound infection (OR: 3.4; p=0.04). The remaining no '1' polyfilament suture (petcryl) after suturing rectus sheath can be safely used to close skin suture in cesarean section.

  14. Efficacy of Intravenous Ondansetron for Prevention of Postspinal Shivering during Lower Segment Cesarean Section: A Double-Blinded Randomized Trial

    Science.gov (United States)

    Nallam, Srinivasa Rao; Cherukuru, Kavya; Sateesh, Gokul

    2017-01-01

    Background and Aims: Elective lower segment cesarean section under spinal anesthesia is frequently associated with shivering. Ondansetron has been shown to be effective for postspinal shivering. In the present study, we compare the efficacy of ondansetron to prevent postspinal shivering in parturients undergoing cesarean delivery under spinal anesthesia. Materials and Methods: A total of eighty full-term parturients scheduled for elective lower segment cesarean section under spinal anesthesia were randomly allocated into two groups. Group O received 8 mg/4 ml ondansetron, and Group S received 4 ml normal saline intravenously immediately before induction of spinal anesthesia. The level of sensory block, core body temperature, shivering score, and presence or absence of nausea and vomiting during the perioperative period, 1st and 5th min neonates Apgar scores were recorded. The data analysis was carried out with Z-test and Chi-square test. Results: Ten percent (4/40) of patients in Group O and 42.5% (17/40) of patients in Group S had Grade III shivering during the perioperative period and that was treated with intravenous injection tramadol (P = 0.001). Two patients (5%) in ondansetron and 19 patients (47.5%) in control group had nausea and vomiting (P shivering, nausea and vomiting during lower segment cesarean section under spinal anesthesia with no effect on Apgar score. PMID:28663651

  15. Serial Change in Cervical Length for the Prediction of Emergency Cesarean Section in Placenta Previa.

    Directory of Open Access Journals (Sweden)

    Jae Eun Shin

    Full Text Available To evaluate whether serial change in cervical length (CL over time can be a predictor for emergency cesarean section (CS in patients with placenta previa.This was a retrospective cohort study of patients with placenta previa between January 2010 and November 2014. All women were offered serial measurement of CL by transvaginal ultrasound at 19 to 23 weeks (CL1, 24 to 28 weeks (CL2, 29 to 31 weeks (CL3, and 32 to 34 weeks (CL4. We compared clinical characteristics, serial change in CL, and outcomes between the emergency CS group (case group and elective CS group (control group. The predictive value of change in CL for emergency CS was evaluated.A total of 93 women were evaluated; 31 had emergency CS due to massive vaginal bleeding. CL tended to decrease with advancing gestational age in each group. Until 29-31 weeks, CL showed no significant differences between the two groups, but after that, CL in the emergency CS group decreased abruptly, even though CL in the elective CS group continued to gradually decrease. On multivariate analysis to determine risk factors, only admissions for bleeding (odds ratio, 34.710; 95% CI, 5.239-229.973 and change in CL (odds ratio, 3.522; 95% CI, 1.210-10.253 were significantly associated with emergency CS. Analysis of the receiver operating characteristic curve showed that change in CL could be the predictor of emergency CS (area under the curve 0.734, p < 0.001, with optimal cutoff for predicting emergency cesarean delivery of 6.0 mm.Previous admission for vaginal bleeding and change in CL are independent predictors of emergency CS in placenta previa. Women with change in CL more than 6 mm between the second and third trimester are at high risk of emergency CS in placenta previa. Single measurements of short CL at the second or third trimester do not seem to predict emergency CS.

  16. The Association Between Preterm Premature Rupture of Membranes and Surgical Site Infection Following Cesarean Section

    Directory of Open Access Journals (Sweden)

    Mehmet Çınar

    2016-12-01

    CONCLUSION:  Independent risk factors for post-cesarean SSIs are younger age, obesity, diabetes, hypertension, premature rupture of membranes. Information regarding higher rates of SSIs should be provided to obese women undergoing cesarean delivery, especially when diabetes and hypertension coexists.

  17. Sonographic Measurement of Lower Uterine Segment Thickness to Predict Uterine Rupture During a Trial of Labor in Women With Previous Cesarean Section: A Meta-analysis

    NARCIS (Netherlands)

    Kok, N.; Wiersma, I. C.; Opmeer, B. C.; de Graaf, I. M.; Mol, B. W.; Pajkrt, E.

    2014-01-01

    Along with the increasing rate of cesarean section (CS) births has been a concomitant decrease in the rate of vaginal birth after cesarean (VBAC), mostly due to concerns about uterine rupture during a trial of labor (TOL). The risk of uterine rupture in laboring women with a previous CS must be

  18. Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections.

    Science.gov (United States)

    Haas, David M; Morgan, Sarah; Contreras, Karenrose

    2014-12-21

    Cesarean delivery is one of the most common surgical procedures performed by obstetricians. Infectious morbidity after cesarean delivery can have a tremendous impact on the postpartum woman's return to normal function and her ability to care for her baby. Despite the widespread use of prophylactic antibiotics, postoperative infectious morbidity still complicates cesarean deliveries. To determine if cleansing the vagina with an antiseptic solution before a cesarean delivery decreases the risk of maternal infectious morbidities, including endometritis and wound complications. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (10 December 2014). We included randomized and quasi-randomized trials assessing the impact of vaginal cleansing immediately before cesarean delivery with any type of antiseptic solution versus a placebo solution/standard of care on post-cesarean infectious morbidity. We independently assessed eligibility and quality of the studies. Seven trials randomizing 2816 women (2635 analyzed) evaluated the effects of vaginal cleansing (all with povidone-iodine) on post-cesarean infectious morbidity. The risk of bias was generally low, with the quality of most of the studies being high. Vaginal preparation immediately before cesarean delivery significantly reduced the incidence of post-cesarean endometritis from 8.3% in control groups to 4.3% in vaginal cleansing groups (average risk ratio (RR) 0.45, 95% confidence interval (CI) 0.25 to 0.81, seven trials, 2635 women). The risk reduction was particularly strong for women who were already in labor at the time of the cesarean delivery (7.4% in the vaginal cleansing group versus 13.0% in the control group; RR 0.56, 95% CI 0.34 to 0.95, three trials, 523 women) and for women with ruptured membranes (4.3% in the vaginal cleansing group versus 17.9% in the control group; RR 0.24, 95% CI 0.10 to 0.55, three trials, 272 women). No other outcomes realized statistically significant

  19. Use of Robson classification to assess cesarean section rate in Brazil: the role of source of payment for childbirth.

    Science.gov (United States)

    Nakamura-Pereira, Marcos; do Carmo Leal, Maria; Esteves-Pereira, Ana Paula; Domingues, Rosa Maria Soares Madeira; Torres, Jacqueline Alves; Dias, Marcos Augusto Bastos; Moreira, Maria Elisabeth

    2016-10-17

    Cesarean section (CS) rates are increasing worldwide but there is some concern with this trend because of potential maternal and perinatal risks. The Robson classification is the standard method to monitor and compare CS rates. Our objective was to analyze CS rates in Brazil according to source of payment for childbirth (public or private) using the Robson classification. Data are from the 2011-2012 "Birth in Brazil" study, which used a national hospital-based sample of 23,940 women. We categorized all women into Robson groups and reported the relative size of each Robson group, the CS rate in each group and the absolute and relative contributions made by each to the overall CS rate. Differences were analyzed through chi-square and Z-test with a significance level of cesarean delivery before labor), group 5 (multiparous, term, cephalic presentation and previous cesarean section) and group 10 (cephalic preterm pregnancies), which accounted for more than 70 % of CS carried out in the country. High-risk women had significantly greater CS rates compared with low-risk women in almost all Robson groups in the public sector only. Public policies should be directed at reducing CS in nulliparous women, particularly by reducing the number of elective CS in these women, and encouraging vaginal birth after cesarean to reduce repeat CS in multiparous women.

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

    Directory of Open Access Journals (Sweden)

    Cheryl A. Moyer

    2010-01-01

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

  1. Sexual satisfaction after child birth: vaginal versus elective cesarean delivery

    OpenAIRE

    Hantoushzadeh S; Shariat M; Rahimi Foroushani A; Ramezanzadeh F; Masoumi M

    2009-01-01

    "nBackground: The perception of impairment of sexual function after childbirth in vaginal delivery (as a complication) makes pregnant women to request elective cesarean section. But this conception is more related to culture. Therefore we studied women's sexual health after childbirth to assess whether women who underwent cesarean section experienced better sexual health in the postnatal period than women with vaginal births. "nMethods: A cohort study was conducted on 303 primi...

  2. Elective cesarean section as a woman’s choice: a narrative literature review

    Directory of Open Access Journals (Sweden)

    Georgia Pontiki

    2017-06-01

    Full Text Available The natural childbirth is the most indicated way of birth, while the cesarean section (C-section is an intervening procedure that includes risks and is addressed to women with serious medical contraindications for natural birth. However, there has been a rapid increase in C-section deliveries in recent years. At the same time, there has been a tendency of the couples to choose a C-section without medical evidence. The purpose of the present review is the exploration of the motivation and the factors that urge the new mothers to choose a C-section while there is no medical evidence. In many studies researchers correlate the C-section choice with the increased use of biomedical engineering, the medical malpractice, and the increased concerns of health professionals for possible complications along with the previous delivery experience. A woman chooses the way of delivery under not only external but also internal factors such as personality, beliefs related to the baby’s and her security, the previous traumatic delivery experiences, the preexisting psychological problems and the delivery phobia. The C-section is a way of delivery with certain indications and many times is the only way in order the delivery to be safe for both the mother and the baby. It is very important for the health professionals, in cases where the medical evidence allows the choice, to clarify all the consequences, both positive and negative that could accompany each choice, so that the procedure of the final decision to be made in the best possible way for the benefit of the mother and the baby.

  3. Comparison of patient-controlled intravenous analgesia with sufentanil versus tramadol in post-cesarean section pain management and lactation after general anesthesia - a prospective, randomized, double-blind, controlled study.

    Science.gov (United States)

    Chi, Xiaohui; Li, Man; Mei, Wei; Liao, Mingfeng

    2017-01-01

    Acute pain is a common complication following cesarean section under general anesthesia. Post-cesarean section pain management is important for both the mother and the newborn. This study compared the effects of patient-controlled intravenous analgesia (PCIA) using sufentanil or tramadol on postoperative pain control and initiation time of lactation in patients who underwent cesarean section under general anesthesia. Primiparas (n=146) scheduled for cesarean section under general anesthesia were randomized to receive PCIA with sufentanil or tramadol. Movement-evoked and rest-pain intensity were assessed by the Numerical Rating Scale (NRS) postoperatively. The number of PCIA attempts, amount of drug consumed, initiation time of lactation, and Quality of Recovery Score 40 (QoR-40) were recorded at 4, 8, 12, and 24 h postoperatively. Pre- and postoperative serum prolactin levels were recorded. No between-group difference existed in the NRS at rest at any time point postoperatively. Patients on sufentanil had more movement-evoked pain and a higher sedation score at 4, 8, and 12 h postoperatively, as compared with the tramadol group. At 24 h, the QoR-40 was higher in the tramadol group compared with the sufentanil group. No significant between-group differences were present in patient satisfaction and nausea/vomiting scores. Postpartum prolactin levels were significantly higher in the tramadol group versus the sufentanil group, corresponding with a significant delay in initiation of lactation in the latter. PCIA with tramadol may be preferred due to lower movement-evoked pain, higher quality of recovery, and earlier lactation in patients following cesarean section under general anesthesia.

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

    Directory of Open Access Journals (Sweden)

    K Mungrue

    2010-11-01

    Full Text Available Kameel Mungrue, C Nixon, Y David, D Dookwah, S Durga, K Greene, H MohammedFaculty of Medical Sciences, Department of Paraclinical Sciences, Public Health & Primary Care Unit, The University of the West Indies, St Augustine, Trinidad and TobagoObjectives: The objective of this study is to determine the awareness of perception and attitude toward cesarean section (CS in a high-user setting.Design and methods: A cross-sectional design using multistage sampling methods was used to select participants from antenatal and postnatal clinics in a primary health care setting in north Trinidad. A multi-item structured questionnaire was designed and administered by in-depth interviews. Sociodemographic data and data about history of previous pregnancies and outcomes and about knowledge and perceptions of CSs were collected from women aged 16 years and older.Results: Of the women who were eligible for entry into the study, 368 participated. However, participants chose not to respond to some questions. The majority of women (46.2% were found to have very little information from which to make informed decisions about selecting CS as the preferred choice of delivery. Their preference was significantly associated with the perception of safety (maternal or fetal death, P = 0.001, difficulty (complications to mother and baby, P = 0.001, and pain (P = 0.001. Notwithstanding, persons who received information from health care professionals (odds ratio [OR], 1.9; confidence interval, 1.50–2.33 were more likely to have high or adequate levels of information about CSs. Data were analyzed using SPSS software, and ORs were calculated using logistic regression.Conclusion: The majority of women attending antenatal and postnatal clinics in north Trinidad were not sufficiently knowledgeable about CS to enable them to make informed choices. In addition, the information obtained was from an unreliable source, emphasizing the need for information on CS to form a component of a

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

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    Al-Kadri HM

    2015-07-01

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

  6. Abdominal girth and vertebral column length aid in predicting intrathecal hyperbaric bupivacaine dose for elective cesarean section.

    Science.gov (United States)

    Wei, Chang-Na; Zhou, Qing-He; Wang, Li-Zhong

    2017-08-01

    Currently, there is no consensus on how to determine the optimal dose of intrathecal bupivacaine for an individual undergoing an elective cesarean section. In this study, we developed a regression equation between intrathecal 0.5% hyperbaric bupivacaine volume and abdominal girth and vertebral column length, to determine a suitable block level (T5) for elective cesarean section patients.In phase I, we analyzed 374 parturients undergoing an elective cesarean section that received a suitable dose of intrathecal 0.5% hyperbaric bupivacaine after a combined spinal-epidural (CSE) was performed at the L3/4 interspace. Parturients with T5 blockade to pinprick were selected for establishing the regression equation between 0.5% hyperbaric bupivacaine volume and vertebral column length and abdominal girth. Six parturient and neonatal variables, intrathecal 0.5% hyperbaric bupivacaine volume, and spinal anesthesia spread were recorded. Bivariate line correlation analyses, multiple line regression analyses, and 2-tailed t tests or chi-square test were performed, as appropriate. In phase II, another 200 parturients with CSE for elective cesarean section were enrolled to verify the accuracy of the regression equation.In phase I, a total of 143 parturients were selected to establish the following regression equation: YT5 = 0.074X1 - 0.022X2 - 0.017 (YT5 = 0.5% hyperbaric bupivacaine volume for T5 block level; X1 = vertebral column length; and X2 = abdominal girth). In phase II, a total of 189 participants were enrolled in the study to verify the accuracy of the regression equation, and 155 parturients with T5 blockade were deemed eligible, which accounted for 82.01% of all participants.This study evaluated parturients with T5 blockade to pinprick after a CSE for elective cesarean section to establish a regression equation between parturient vertebral column length and abdominal girth and 0.5% hyperbaric intrathecal bupivacaine volume. This equation can accurately

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

    Science.gov (United States)

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

    2010-01-01

    Cesarean delivery is frequently complicated by surgical site infections (SSIs), endometritis and urinary tract infection. Most SSIs occur after discharge from hospital, and are increasingly being used as performance indicators. Worldwide, the rate of cesarean delivery is increasing. Evidence-based guidelines recommended the use of prophylactic antibiotics prior to surgical incision. An exception is made for cesarean delivery, where narrow-range antibiotics are administered post umbilical cord clamping because of putative neonatal benefit. However, recent evidence supports the use of pre-incision, broad-spectrum antibiotics which result in less maternal morbidity with no disadvantage to the neonate. PMID:21159119

  8. [Cervical ripening after previous cesarean section with Foley catheter: A prospective study of 41 patients].

    Science.gov (United States)

    Lamourdedieu, C; Gnisci, A; Marcelli, M; Heckenroth, H; Gamerre, M; Agostini, A

    2015-05-01

    Effectiveness of cervical ripening with Foley catheter for patients requiring labor induction with a previous cesarean section and unfavorable cervical conditions. Prospective unicentric study conducted between 1 April 2011 and 31 October 2013 on 41 patients with medical indication for labor induction with a Bishop's scorecesarean section. Outcomes evaluated were mode of delivery, Bishop's score variations and maternal or neonatal complications. Cervical ripening was performed in 39 patients and 17 (43.5%) were delivered vaginally. A total of 24/39 (61.5%) patients were put into work and 10/39 (25.6%) came into work immediately after removal of the Foley catheter. The average score improvement Bishop was 2.7±0.6 points. No maternal or fetal complication was reported. Foley catheter is an interesting procedure in patients with previous cesarean section and unfavorable cervical conditions requiring labor induction. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  9. [UTERINE SCAR DEFECT IN WOMEN AFTER CESAREAN SECTION - ULTRASOUND AND HYSTEROSCOPIC DIAGNOSI.

    Science.gov (United States)

    Ganovska, A; Kovachev, S

    The aim of our study was to determine the frequency of defect scar in women with clinical complaints after Cesarean section (CS) diagnosed by transvaginal ultrasonography and diagnostic hysteroscopy as well as to determine the degree of match between the data obtained by the two methods. The study was retrospective and was conducted in the Department of General Oncology and Gynecology, MMA for the period from 2014 to 2016 years. Included are 25 non-pregnant premenopausal women aged 29 to 45 years with clinical symptoms. The main inclusion criteria were delivery by CS, overt clinical gynecological symptoms and positive imaging findings of a defect in the scar. The main gynecological symptoms are: postmenstrual and breakthrough bleeding, dysmenorrhea, dispaureny and idiopathic pain over the symphysis. Imaging studies were performed using two-dimensional transvaginal sonography and diagnostic hysteroscopy. The data are processed by Social statistic STAT 10. We used Chi square statistic test 12.5 (Pearson). Data were compared to two independent groups. Results were statistically significant at values of pcesarean section (CS) increases and frequency of early and late complications of this surgery. Irregular uterine bleeding in women after CS and a lack of other organic causes are the result of a defect in uterine scar. First choice for the diagnosis of this type of pathology is ultrasonography examination followed by diagnostic hysteroscopy. It is conducting further studies on the etiology of this complication.

  10. Prediction of hypotension during spinal anesthesia for elective cesarean section by altered heart rate variability induced by postural change.

    Science.gov (United States)

    Sakata, K; Yoshimura, N; Tanabe, K; Kito, K; Nagase, K; Iida, H

    2017-02-01

    Maternal hypotension is a common complication during cesarean section performed under spinal anesthesia. Changes in maternal heart rate with postural changes or values of heart rate variability have been reported to predict hypotension. Therefore, we hypothesized that changes in heart rate variability due to postural changes can predict hypotension. A total of 45 women scheduled to undergo cesarean section under spinal anesthesia were enrolled. A postural change test was performed the day before cesarean section. The ratio of the power of low and high frequency components contributing to heart rate variability was assessed in the order of supine, left lateral, and supine. Patients who exhibited a ⩾two-fold increase in the low-to-high frequency ratio when moving to supine from the lateral position were assigned to the postural change test-positive group. According to the findings of the postural change test, patients were assigned to the positive (n=22) and negative (n=23) groups, respectively. Hypotension occurred in 35/45 patients, of whom 21 (60%) were in the positive group and 14 (40%) were in the negative group. The incidence of hypotension was greater in the positive group (Pcesarean section. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. A multifaceted prevention program to reduce infection after cesarean section: Interventions assessed using an intensive postdischarge surveillance system.

    Science.gov (United States)

    Ng, Wil; Brown, Adrian; Alexander, Doreen; Ho, Man Fan; Kerr, Bonnie; Amato, Michelle; Katz, Kevin

    2015-08-01

    We assessed the effects of the components of a multifaceted and evidence-based caesarean-section surgical site infection (SSI) prevention program on the SSI rate after cesarean section using a postdischarge surveillance (PDS) system. Multiple prevention interventions were serially implemented. SSI case finding was undertaken through active inpatient surveillance and intensive PDS using a standardized form at the 6-week postdischarge visit. SSI diagnosis was made using the Centers for Disease Control and Prevention standardized criteria. All cesarean deliveries between July 2007 and December 2012 were included. Changes in SSI rate were analyzed using segmented regression analysis. Nine thousand four hundred forty-two cesarean sections were assessed during the study period. PDS forms were completed for 7,985 women (85%). SSI was detected in 451 cases (5.6%): 91% were superficial, 9% were deep/organ-space infections. The SSI rate decreased incrementally from 8.2% at baseline to 4.1%; significant decreases were observed after optimizing antibiotic prophylaxis timing, using a surgical safety checklist, and enhancing prenatal education to discourage prehospital self-removal of hair. Nonelective surgeries or those undertaken after >12 hours of rupture of membranes had a significantly higher rate compared with those without either risk factor (6.3% vs 3.2%; P section. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Gutman, Yaira; Tabak, Nili

    2011-01-01

    Objective. In recent years, more and more delivery rooms have allowed husbands/partners to be present during a Cesarean section Nonetheless, many still oppose the idea. The study is designed to investigate the attitudes of Israeli gynecologists, anesthetists, operating-room nurses, and midwives on this issue. Design. The study's theoretical model comes from Fishbein and Ajzen's theory of reasoned action. A self-administered questionnaire was submitted to convenience sample. Subjects. 96 gynecologists, anesthetists, midwives, and operating-room nurses. Results. Significant differences were found between the occupational subgroups. Most of the findings supported the four hypotheses tested and confirmed earlier studies designed to verify the theoretical model. Conclusions. The main conclusion drawn is that delivery and operating-room staff need to be trained in the skills needed to promote the active participation of the baby's father in delivery and, if necessary, in a Cesarean section. PMID:21994815

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

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    Yaira Gutman

    2011-01-01

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

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

    Science.gov (United States)

    Sabbagh-Sequera, Miriam; Loidi-García, Jose María; Romero-Vázquez, Gloria Maria

    2015-01-01

    Pregnancy pathologies in general, and pre-eclampsia in particular, are problems usually treated in post-anesthesia recovery and hospitalization units. Pre-eclampsia is the most frequent form of hypertension associated with pregnancy (50%). It affects from 7% to 10% of pregnant women. It is known as pregnancy and puerperium multisystem syndrome. It is due to a reduction of the systemic perfusion generated by the vasospasms and the activation of the coagulation systems. A clinical case is presented of the immediate post-surgery period of a patient, who has been operated on cesarean section after having been diagnosed with pre-eclampsia. A nursing care plan was prepared, based on Marjory Gordon functional patterns and guided by NANDA-NOC-NIC taxonomy, where 6 nursing diagnoses, which are the basis for the fulfillment of this nursing process, are identified: Risk of infection, excess fluid volume, risk of bleeding, insufficient knowledge about its pathological process, severe pain, and anxiety. The application of this care plan leads to an improvement in the patient care and in the work organization. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  15. Cesarean section in relation to self-esteem and parenting among new mothers in southwestern Nigeria.

    Science.gov (United States)

    Loto, Olabisi Morebise; Adewuya, Abiodun O; Ajenifuja, Olusegun K; Orji, Ernest O; Ayandiran, Emmanuel Olufemi; Owolabi, Alexander T; Ade-Ojo, Idowu Pius

    2010-01-01

    Maternal psychopathology and self-esteem during childbirth may have an effect on maternal parenting self-efficacy. This study aimed to asses the self-esteem of newly delivered primiparous mothers who had cesarean section (CS) in relation to their parenting self-efficacy. A total of 115 primiparous women who delivered by CS were compared with 97 matched controls who had vaginal delivery during the same period. They completed the Rosenberg self-esteem scale prior to discharge. They also completed the parent-child relationship questionnaire at six weeks postpartum, together with the Rosenberg self-esteem scale. The mean score on the Rosenberg self-esteem scale was significantly lower for the CS group, both prior to discharge (p = 0.006) and at six weeks (p parent-child relationship questionnaire was also lower in those who had CS compared with those who had vaginal delivery (p self-esteem and predicts poor parenting self-efficacy in the postnatal period. Psychological support and techniques to improve self-esteem and parenting should be incorporated into the management of women having CS.

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

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    Heydar Noroozinia

    2013-03-01

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

  17. Ongoing Transmission of HCV: Should Cesarean Section be Justified? Data Mining Discovery.

    Science.gov (United States)

    Elrazek, Abd; Saab, Samy; Foad, Mahmoud; Elgohary, Elsayed A; Sallam, Mohammad M; Nawara, Abdallah; Ismael, Ali; Morsi, Samar S; Salah, Altaher; Alboraie, Mohamed; Bhagavathula, Akshaya Srikanth; Zayed, Marwa; Elmasry, Hossam; Salem, Tamer Z

    2017-03-01

    Over the past few decades, cesarean section (CS) rates are steadily increasing in most of the middle- and high-income countries. However, most of the pregnant women (particularly undergoing CS) are not screened for hepatitis C virus (HCV); hence, neonates born to HCV-positive mother could be a source of future HCV infection. In this study, the role of the CS and other surgical interventions in HCV transmission in Egypt, the highest endemic country of HCV-4, was investigated. From January to June 2016, a prospective cohort study was conducted among 3,836 pregnant women in both urban and rural areas across Egypt for HCV screening in both mothers and neonates born to HCV-positive mother. All pregnant women were screened during third trimester or just before delivery, neonates born to HCV-positive mothers were evaluated within 24-h postdelivery to record vertical transmission cases. Data mining (DM)-driven computational analysis was used to quantify the findings. Among 3,836 randomized pregnant women, HCV genotype 4 was identified in 80 women (2.08%). Out of 80 HCV-infected women, 18 have experienced surgical intervention (22.5%) and 62 CS (77.5%). HCV vertical transmission was identified in 10 neonates, 10/80 (12.5%). Screening women who had experienced surgical intervention or CS during child bearing period and before pregnancy might prevent HCV mother-to-child transmission (MTCT). CS should be ethically justified to decrease global HCV transmission.

  18. A giant cardiac hydatid cyst presenting with chest pain and ventricular tachycardia in a pregnant woman undergoing cesarean section

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    Mehmet Yaman

    2016-09-01

    Full Text Available Cyst hydatid disease is an infectious disease caused by development of the larval form of Echinococcus granulosus in humans. Cardiac involvement of this disease is a rare condition, and if present, it is most commonly located in the left ventricle. Interventricular septal involvement is observed only in 4% of these cases. Herein, we report a case of cyst hydatid located at interventricular septum causing chest pain and ventricular tachycardia during cesarean section.

  19. Incisional negative pressure therapy to prevent wound complications following cesarean section in morbidly obese women: a pilot study.

    Science.gov (United States)

    Mark, Katrina S; Alger, Lindsay; Terplan, Mishka

    2014-08-01

    We sought to evaluate the efficacy of incisional negative pressure therapy in decreasing postoperative wound complications when placed prophylactically over clean, closed incisions following cesarean section in obese patients. This was a retrospective cohort study comparing rates of wound complications following cesarean sections in morbidly obese women prior to and following the institution of standard use of prophylactic incisional negative pressure therapy. All women with a body mass index greater than 45 kg/m(2) undergoing cesarean section in a 2-year period in a single institution were included. The exposure was incisional negative pressure therapy, which began in September 2009, versus standard wound dressing used in the previous year. The main outcome was wound complication identified by ICD-9 codes. Demographic and wound outcomes were compared with χ(2) and t tests. Stata version 11.0 was used for all analysis. A total of 63 women met the inclusion criteria, 21 of whom received negative pressure wound therapy. The historical comparison and exposure groups were similar in all characteristics studied with the exceptions of length of surgery (64 vs 76 minutes, P = .03), length of labor (78 vs 261 minutes, P = .02), scheduled versus nonscheduled (77% vs 52%, P = .04), and mean age (29.5 vs 26.1 years, P = .04), respectively. There were 5 wound complications in the control group (10.4%) and none (0%) in the study group (P = .15). This pilot study suggests a decrease in wound complications in morbidly obese women receiving incisional negative pressure therapy following cesarean section. © The Author(s) 2013.

  20. Effect of intra-operative glove changing during cesarean section on post-operative complications: a randomized controlled trial.

    Science.gov (United States)

    Scrafford, Jonathan D; Reddy, Buvana; Rivard, Colleen; Vogel, Rachel Isaksson

    2018-03-19

    To compare the rates of wound-related complications among women undergoing a cesarean section when the surgical team used intra-operative glove changing versus usual care. All women undergoing a cesarean section at a single, county hospital were randomized to usual care or intra-operative glove changing prior to abdominal closure. Participants were randomized at the time of decision for cesarean section; surgeons were not blinded to the randomization arm. The primary outcome was any wound-related complication, including wound hematoma, seroma, skin separation of at least 1 cm, wound infection, or other incisional abnormality requiring treatment within 8 weeks of surgery. To detect a reduction in the primary outcome from 17% in the control group to 9% in the intervention group with 80% power, a total of 554 women (277 per group) were required. Secondary outcomes included other infectious complications including endometritis and other superficial or deep soft tissue infections. From August 2015 to November 2016, 277 women were randomized to usual care and 276 women were randomized to intra-operative glove changing. The two groups were well balanced in terms of demographic data, comorbid conditions and surgical characteristics. Intra-operative glove changing led to a significant decrease in composite wound complications from 13.6% in the control group to 6.4% in the intervention group (p = 0.008). Intra-operative glove changing prior to abdominal closure during cesarean section significantly reduced the incidence of post-operative wound complications.

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

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    Young Sung Kim

    2014-07-01

    Full Text Available Cardiovascular comorbidities to the Marfan syndrome may induce hemodynamic instability especially in the parturients during labor or delivery. For anesthesiologists, it is challenging to maintain hemodynamic stability during Cesarean section in those patients with Marfan syndrome. Remifentanil is an ultra-short-acting opioid with rapid onset and offset of action which provides cardiovascular stability during surgery. Together with remifentanil, the use of a laryngeal mask airway can reduce the risk of hypertensive response followed by tracheal intubation. We describe the successful administration of remifentanil and application of laryngeal mask airway for emergent Cesarean section performed under general anesthesia in a patient with Marfan syndrome complicated by ascending aortic aneurysm and heart failure. The use of remifentanil (loading dose of 1 μg/kg for 1 min, 2 min before induction; thereafter continuous infusion dose of 0.1 μg/kg/min was useful to maintain hemodynamic stability of the parturient throughout the surgery without neonatal respiratory depression. Keywords: Ascending Aortic Aneurysm; Cesarean section; Laryngeal mask airway; Marfan syndrome; Remifentanil

  2. Placenta accreta: incidence and risk factors in an area with a particularly high rate of cesarean section.

    Science.gov (United States)

    Morlando, Maddalena; Sarno, Laura; Napolitano, Raffaele; Capone, Angela; Tessitore, Giovanni; Maruotti, Giuseppe M; Martinelli, Pasquale

    2013-04-01

    Placenta accreta is a rare and potentially life-threatening complication of pregnancy characterized by abnormal adherence of the placenta to the uterine wall. A previously scarred uterus or an abnormal site of placentation in the lower segment is a major risk factor. The aim of this study was to investigate the change in the incidence of placenta accreta and associated risk factors along four decades, from the 1970s to 2000s, in a tertiary south Italian center. We analyzed all cases of placenta accreta in a sample triennium for each decade. The incidence increased from 0.12% during the 1970s, to 0.31% during the 2000s. During the same period, cesarean section rates increased from 17 to 64%. Prior cesarean section was the only risk factor showing a significant concomitant rise. Our results reinforce cesarean section as the most significant predisposing condition for placenta accreta. © 2013 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

  3. The effects of prophylactic bolus phenylephrine on hypotension during low-dose spinal anesthesia for cesarean section.

    Science.gov (United States)

    Lee, H-M; Kim, S-H; Hwang, B-Y; Yoo, B-W; Koh, W-U; Jang, D-M; Choi, W-J

    2016-02-01

    Continuously infused phenylephrine is frequently used to reduce the incidence of hypotension in women undergoing cesarean section under spinal anesthesia, but less is known about the prophylactic bolus method. We evaluated three prophylactic bolus doses of phenylephrine during low-dose spinal anesthesia for cesarean section. One-hundred-and-eighty-four patients were randomized to receive 0.9% saline 2mL (Control Group) or phenylephrine 1.0μg/kg (PHE1 Group), 1.5μg/kg (PHE1.5 Group), or 2.0μg/kg (PHE2 Group) immediately after induction of combined spinal-epidural anesthesia. Maternal blood pressure and heart rate were recorded at 1-min intervals until delivery. Hypotension, defined as systolic blood pressure hypotension resolved. The incidence of nausea, vomiting, bradycardia, and hypertension, as well as Apgar scores and umbilical blood gases, were recorded. The incidence of hypotension was 71.7% (33/46) in the Control Group, 68.9% (31/45) in the PHE1 Group, 37.0% (17/46) in the PHE1.5 Group and 45.7% (21/46) in the PHE2 Group (P=0.001). The total rescue dose of phenylephrine was greater in the Control Group than those in the PHE1.5 Group (Phypotension during low-dose spinal anesthesia for cesarean section. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Double-balloon catheter for induction of labour in women with a previous cesarean section, could it be the best choice?

    Science.gov (United States)

    De Bonrostro Torralba, Carlos; Tejero Cabrejas, Eva Lucía; Marti Gamboa, Sabina; Lapresta Moros, María; Campillos Maza, Jose Manuel; Castán Mateo, Sergio

    2017-05-01

    We analysed the efficacy and safety of double-balloon catheter for cervical ripening in women with a previous cesarean section and which were the most important variables associated with an increased risk of repeated cesarean delivery. We designed an observational retrospective study of 418 women with unfavourable cervices (Bishop Score cesarean delivery, and induction of labour with a double-balloon catheter. Baseline maternal data and perinatal outcomes were recorded for a descriptive, bivariate, and multivariate analysis. A p value cesarean section were dystocia in the previous pregnancy (OR 1.744; CI 95% 1.066-2.846), the absence of previous vaginal delivery (OR 2.590; CI 95% 1.066-6.290), suspected fetal macrosomia (OR 2.410; CI 95% 0.959-6.054), and duration of oxytocin induction period (OR 1.005; CI 95% 1.004-1.006). The area under the curve was 0.789 (p cesarean delivery and unfavourable cervix. In our study, most women could have a vaginal delivery in spite of their risk factors for cesarean delivery. A multivariate model based on some clinical variables has moderate predictive value for intrapartum cesarean section.

  5. The Effect of Educational Intervention based on BASNEF Model on Decreasing the Cesarean Section Rate among Pregnant Women in Khomain Country.

    Science.gov (United States)

    Arefi, Zohreh; Hekamatpou, Davod; Orouji, Mohammad Ali; Shaahmadi, Zahra; Khushemehri, Giti; Shaahmadi, Faramarz

    2015-09-01

    Over the past two decades, the incidence of cesarean section in most countries has increased. Cesarean section increases the risk of death and complications in the mother and fetus. Educational interventions based on behavior change models can play an important role in reduce the rate of cesarean section. The aim of our study is investigation the effect of educational intervention based on BASNEF Model on decreasing of cesarean section rate among pregnant women in Khomain County, from June to November 2013. In this interventional study, 140 nulliparous women who were in their last trimester of pregnancy were randomly allocated to case and control groups. Data gathering instrument was a questionnaire based on BASNEF framework. Data were analyzed by SPSS 14 software. The scores of knowledge, attitudes, subjective norms, and enabling factors in the intervention group than the control group showed a significant difference (p cesarean section. By Chi-square test showed that the difference in the type of delivery between the two groups was statistically significant (p cesarean section.

  6. A life-threatening abdominal abscess secondary to forgotten placental tissue during cesarean section: A case report

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    Elif Ağaçayak

    2013-12-01

    Full Text Available Techniques for cesarean delivery, reliable anesthesia, blood products and antibiotics has led to the expansion of indications for cesarean birth. Nowadays, to be comfortable in anesthesia, medicine and materials used in, severe sterilization techniques, advances in surgery and postoperative care were reduced mortality and morbidity. However; caesarean section still include infection, bleeding, need for transfusion, thromboembolic risks of a longer stay in the hospital, later to be healing, but rather risks, such as the withdrawal of the pain continues. Postpartum hemorrhage inside the remaining placentas compared to normal primary complaint is that too much. At the same time ultrasonographic examination of the uterine involution does not occur, the uterus larger than normally. The aim of this case report, and the absence of postoperative bleeding, complete involution of the uterus that have not been diagnosed, and threatened her life was to present a case which is characterized by abdominal abscess. J Clin Exp Invest 2013; 4 (4: 542-545

  7. Adverse perinatal outcomes associated with trial of labor after cesarean section at term in pregnancies complicated by maternal obesity.

    Science.gov (United States)

    Yao, Ruofan; Crimmins, Sarah D; Contag, Stephen A; Kopelman, Jerome N; Goetzinger, Katherine R

    2017-11-27

    Obesity is associated with higher risks for intrapartum complications. Therefore, we sought to determine if trial of labor after cesarean section (TOLAC) will lead to higher maternal and neonatal complications compared to repeat cesarean section (RCD). This was a retrospective cohort analysis of singleton nonanomalous births between 37 and 42 weeks GA complicated by maternal obesity (body mass index (BMI) ≥ 30 kg/m 2 ) and history of one or two previous cesarean deliveries. Outcomes were compared between TOLAC and RCD. The maternal outcomes of interest included blood transfusion, uterine rupture, hysterectomy, and intensive care unit admission. Neonatal outcomes of interest included 5-minute Apgar score <7, prolonged assisted ventilation, neonatal intensive care unit admission, neonatal seizures, and neonatal death. There were 538,264 pregnancies included. Compared with RCD, TOLAC was associated with an absolute increase in the following neonatal outcomes: low 5-min Apgar score (0.6%, p < .001), neonatal intensive care unit (NICU) admission (0.8%, p < .001), neonatal seizure (0.1 per 1000 births, p = .037), and neonatal death (0.2 per 1000 births, p = .028). Additionally, TOLAC was associated with an absolute increase in following maternal outcomes: blood transfusion (0.1%, p < .001), uterine rupture (0.18%, p < .001) and ICU admission (0.1%, p = .011). TOLAC among obesity pregnancies at term increases the risk of maternal and neonatal complications compared with RCD.

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

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    K Tavakol

    2007-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Adeniji AO

    2013-05-01

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

  10. Use of Robson classification to assess cesarean section rate in Brazil: the role of source of payment for childbirth

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    Marcos Nakamura-Pereira

    2016-10-01

    Full Text Available Abstract Background Cesarean section (CS rates are increasing worldwide but there is some concern with this trend because of potential maternal and perinatal risks. The Robson classification is the standard method to monitor and compare CS rates. Our objective was to analyze CS rates in Brazil according to source of payment for childbirth (public or private using the Robson classification. Methods Data are from the 2011–2012 “Birth in Brazil” study, which used a national hospital-based sample of 23,940 women. We categorized all women into Robson groups and reported the relative size of each Robson group, the CS rate in each group and the absolute and relative contributions made by each to the overall CS rate. Differences were analyzed through chi-square and Z-test with a significance level of < 0.05. Results The overall CS rate in Brazil was 51.9 % (42.9 % in the public and 87.9 % in the private health sector. The Robson groups with the highest impact on Brazil’s CS rate in both public and private sectors were group 2 (nulliparous, term, cephalic with induced or cesarean delivery before labor, group 5 (multiparous, term, cephalic presentation and previous cesarean section and group 10 (cephalic preterm pregnancies, which accounted for more than 70 % of CS carried out in the country. High-risk women had significantly greater CS rates compared with low-risk women in almost all Robson groups in the public sector only. Conclusions Public policies should be directed at reducing CS in nulliparous women, particularly by reducing the number of elective CS in these women, and encouraging vaginal birth after cesarean to reduce repeat CS in multiparous women.

  11. Sexual satisfaction after child birth: vaginal versus elective cesarean delivery

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    Hantoushzadeh S

    2009-03-01

    Full Text Available "nBackground: The perception of impairment of sexual function after childbirth in vaginal delivery (as a complication makes pregnant women to request elective cesarean section. But this conception is more related to culture. Therefore we studied women's sexual health after childbirth to assess whether women who underwent cesarean section experienced better sexual health in the postnatal period than women with vaginal births. "nMethods: A cohort study was conducted on 303 primiparous women who had delivered vaginaly and 315 primiparous delivered by elective cesarean section in seven private hospitals in Tehran, employing data of demographic characteristics like age, education, BMI, obstetric history (weight gain in pregnancy, history of pelvic pain and vaginal discharge, stress incontinence history (prepregnancy and during pregnancy and effect of delivery on sexual satisfaction in several follow-ups until 12 months after delivery. "nResults: Sexual satisfaction after delivery in vaginal group was significantly more than cesarean group. (76% vs 60%, p<0.0001. There was no relation between pelvic pain & delivery type (in several follow- up. "nConclusions: Instead of social conception of have more sexual satisfaction after cesarean delivery, outcomes from this study provide no basis for advocating cesarean section as a way to protect women's sexual function after childbirth. Therefore Request of cesarean section by mother for having more sexual satisfaction after childbirth is not logic.

  12. Spinal Anaesthesia for Cesarean Section in a Patient with Vascular Type Ehlers-Danlos Syndrome

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    Jeffrey M. Carness

    2018-01-01

    Full Text Available We report the administration of spinal anaesthesia for cesarean delivery in a parturient with vascular Ehlers-Danlos syndrome. Parturients who genetically inherit this disorder are at risk for significant morbidity and mortality. Risks during pregnancy include premature labor, uterine prolapse, and uterine rupture. Additionally, such laboring parturients are at increased risk of hemodynamic volatility, vascular stress, and severe postpartum hemorrhage. Instrumented delivery and cesarean delivery bring additional risks. Nonpregnancy-related complications include excessive bleeding, intestinal rupture, cardiac valvular dysfunction, and arterial dissection. Despite the complexity of this condition, literature focusing on specific intraoperative anaesthetic management is sparse.

  13. Serial Change in Cervical Length for the Prediction of Emergency Cesarean Section in Placenta Previa.

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    Shin, Jae Eun; Shin, Jong Chul; Lee, Young; Kim, Sa Jin

    2016-01-01

    To evaluate whether serial change in cervical length (CL) over time can be a predictor for emergency cesarean section (CS) in patients with placenta previa. This was a retrospective cohort study of patients with placenta previa between January 2010 and November 2014. All women were offered serial measurement of CL by transvaginal ultrasound at 19 to 23 weeks (CL1), 24 to 28 weeks (CL2), 29 to 31 weeks (CL3), and 32 to 34 weeks (CL4). We compared clinical characteristics, serial change in CL, and outcomes between the emergency CS group (case group) and elective CS group (control group). The predictive value of change in CL for emergency CS was evaluated. A total of 93 women were evaluated; 31 had emergency CS due to massive vaginal bleeding. CL tended to decrease with advancing gestational age in each group. Until 29-31 weeks, CL showed no significant differences between the two groups, but after that, CL in the emergency CS group decreased abruptly, even though CL in the elective CS group continued to gradually decrease. On multivariate analysis to determine risk factors, only admissions for bleeding (odds ratio, 34.710; 95% CI, 5.239-229.973) and change in CL (odds ratio, 3.522; 95% CI, 1.210-10.253) were significantly associated with emergency CS. Analysis of the receiver operating characteristic curve showed that change in CL could be the predictor of emergency CS (area under the curve 0.734, p placenta previa. Women with change in CL more than 6 mm between the second and third trimester are at high risk of emergency CS in placenta previa. Single measurements of short CL at the second or third trimester do not seem to predict emergency CS.

  14. Challenges in the transvaginal management of abnormal uterine bleeding secondary to cesarean section scar defect.

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    Wang, Chin-Jung; Huang, Huei-Jean; Chao, Angel; Lin, Yu-Pin; Pan, Yi-Jung; Horng, Shang-Gwo

    2011-02-01

    Research suggests that the resectoscopic management of abnormal uterine bleeding (AUB) following cesarean section (CS) is safe and effective. There is, however, a lack of complementary data from routine clinical practice. We aimed to evaluate the efficacy of resectoscopic remodeling of the CS scar in the management of post CS AUB (pCSAUB). The case notes of 57 women with pCSAUB who had undergone a resectoscopic remodeling procedure were reviewed retrospectively. Primary outcome measures were the duration of preoperative and postoperative menstruation, and postoperative menstrual change. Secondary outcome measures were the impact of patient-dependent variables on the success of the resectoscopic remodeling procedure. The CS scar was located using transvaginal ultrasonography and hysteroscopy. The remodeling procedure was performed with a hysteroscopic resectoscope, and commenced with resection of the fibromuscular scar. This started at the roof of the scar pouch and progressed towards the external os. It then continued along a line parallel to the axis of the cervical canal. The exposed dilated blood vessels and endometrial-like tissue in the roof of the remaining pouch were electrocauterized with a roller-ball electrode. The mean operating time was 30.2 ± 6.6 min. There was a significant difference in the mean duration of preoperative and postoperative menstruation (12.9 ± 2.9 days and 9.4 ± 4.1 days, respectively; p uterine remodeling is an appropriate therapy in patients with pCSAUB and an anteflexed uterus. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  15. Evaluation of risk factor and complication of umbilical cord prolapsed in cesarean section

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    Zahra Rezaee

    2015-03-01

    Full Text Available Objectives: Considering the rarity of umbilical cord prolapse (UCP and lack of accurate data about the risk factors and health outcomes, we aimed to evaluate cases of cesarean section (CS due to UCP in order to reduce treatment costs and provide information about the mortality and morbidity associated with this condition. Patients & Methods: Of 35,259 cases of CS performed in four hospitals during 2004-2012, 103 cases of UCP were selected as the case group; on the other hand, 318 cases without UCP were classified as the control group. Information was extracted from patients' records and analyzed by SPSS version 18. Results: Prevalence of UCP was estimated at 0.2%. In the case group, the active phase of labor was reported 1.4 times (81% vs 57%-P<0.00, engagement 8 times (14% vs 2% -P<0.001, transverse presentation 8 times (6% vs 2%-P<0.002, grand multiparity 3.9 times (4% vs 0-P<0.001, oligohydramnios 4.7 times (5% vs. 0-P<0.0001, and polyhydramnios 5.9 times (6% vs 0 - P<0.001. UCP was more prevalent in post-term deliveries (P<0.043. One-minute Apgar score < 7 was 3 times more prevalent in neonates of the case group (P<0.00. Prepartum vaginal bleeding was 4 times more common in the case group, compared to the control group; also, decreased fetal movement and heart rate drop were more prevalent in the case group. Mortality rate was 5.2% in the case group and 1.7% in the control group. Overall, the control group had a better general health at discharge, compared to the case group. Conclusion: A statistically significant correlation was detected between UCP and gestational age, active phase of labor, fetal presentation, engagement, parity, and amniotic fluid volume.

  16. Rising trends and inequalities in cesarean section rates in Pakistan: Evidence from Pakistan Demographic and Health Surveys, 1990-2013.

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    Mumtaz, Sarwat; Bahk, Jinwook; Khang, Young-Ho

    2017-01-01

    Despite global efforts to improve maternal health, many developing countries including Pakistan have failed to achieve the target of a 75% reduction in maternal deaths by 2015. Addressing socioeconomic inequalities in access to emergency obstetric care is crucial for reducing the maternal mortality rate. This study was done to examine the time trends and socioeconomic inequalities in the utilization of cesarean section (C-section) in Pakistan during 1990-2013. We used data from the Pakistan Demographic and Health Surveys (PDHS) conducted during 1990 to 2013. All these surveys are nationally representative surveys of ever-married women aged 15-49 years with a sample size of 6611, 10,023, and 13,558 women in 1990-1991, 2006-2007, and 2012-2013, respectively, with an overall response rate of over 90%. The unit of analysis for this study was women with their most recent live birth in the five years preceding the surveys. Bivariate analyses and multivariable logistic regression models were employed to investigate the prevalence of cesarean sections according to selected sociodemographic characteristics of women. C-section rates were found to have increased during this period, with an especially significant rise from 2.7% in 1990-1991 to 15.8% in 2012-2013 with lower utilization among the non-educated women (7.5%), compared with the women with higher education (40.3%). C-section rates ranged from 5.5% in the poorest women to 35.3% in the richest women. Only 11.5% of the rural women had a C-section compared to 25.6% of the urban women. A greater likelihood of having a cesarean section was observed in the richest, highly educated, and urban-living women while there was no significant difference observed in cesarean section rates between the private and public sectors in all three surveys. To improve maternal health, routine monitoring and evaluation of the provision of emergency obstetric services are needed to address the underuse of C-section in poor and rural areas and

  17. A Complicated Case of Tacrolimus-Induced Rapid Remission after Cesarean Section in the Early Third Trimester for Refractory Severe Ulcerative Colitis Flaring in the Initial Period of Gestation

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    Takashi Mizushima

    2011-04-01

    Full Text Available A 36-year-old woman who had been diagnosed with ulcerative colitis at the age of 17 years was referred to our hospital because of severe abdominal pain and repeated bloody diarrhea that persisted during pregnancy despite combination therapy with high-dose corticosteroids and weekly granulocyte and monocyte adsorptive apheresis (GMA. She underwent combination therapy consisting of high-dose corticosteroids, intensive GMA (two sessions per week and vancomycin, which was used to eradicate Clostridium difficile, under total parenteral nutrition control until the estimated weight of her fetus reached 1,000 g. This combination therapy was partially successful, resulting in almost complete disappearance of abdominal pain and a marked decrease in stool frequency. However bloody diarrhea persisted and the patient developed anemia and hypoalbuminemia and was unable to prolong her gestation time. Cesarean section was conducted at 28 weeks of gestation without any congenital abnormalities or neurological defects. Oral administration of tacrolimus was begun 7 days after cesarean section, which was followed by rapid induction of remission. Corticosteroids were then gradually tapered off. Tacrolimus is one therapeutic option after cesarean section in pregnant patients who do not respond well to GMA and high-dose corticosteroids for persistent active ulcerative colitis.

  18. Effect of low dose of intrathecal pethidine on the incidence and intensity of shivering during cesarean section under spinal anesthesia: a randomized, placebo-controlled, double-blind clinical trial.

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    Shami, Shoaleh; Nasseri, Karim; Shirmohammadi, Mousa; Sarshivi, Farzad; Ghadami, Negin; Ghaderi, Ebrahim; Pouladi, Mokhtar; Barzanji, Arvin

    2016-01-01

    Shivering is among the unpleasant and potentially harmful side effects of spinal anesthesia. The aim of this randomized double-blind clinical trial was to compare the antishivering effect of two different doses of intrathecal pethidine on the incidence and intensity of shivering and other side effects in patients who underwent cesarean section. In this study, 150 parturient females scheduled for nonemergent cesarean section were randomly allocated to three groups. Spinal anesthesia was performed with 0.5% hyperbaric bupivacaine (12.5 mg), plus 0.5 mL of 0.9% saline in the standard group (S group), and the same dose of bupivacaine with 5 mg (P5 group) or 10 mg of pethidine (P10 group). Demographic and surgical data, incidence and intensity of shivering (primary outcome), hemodynamic indices, forehead and core temperatures, maximum sensory level, Apgar scores, and adverse events were evaluated by a blinded observer. There were no significant differences between the three study groups regarding the demographic and surgical data, hemodynamic indices, core temperatures, and maximum sensory level ( P >0.05). The incidence and intensity of shivering were significantly less in the P5 and P10 groups ( P shivering during cesarean section, without having major side effects.

  19. Anesthesia for Cesarean Delivery: A Cross-Sectional Survey of Provincial, District, and Mission Hospitals in Zimbabwe.

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    Lonnée, Herman A; Madzimbamuto, Farai; Erlandsen, Ole R M; Vassenden, Astrid; Chikumba, Edson; Dimba, Rutenda; Myhre, Arne K; Ray, Sunanda

    2017-12-29

    Cesarean delivery is the most common surgical procedure in low- and middle-income countries, so provision of anesthesia services can be measured in relation to it. This study aimed to assess the type of anesthesia used for cesarean delivery, the level of training of anesthesia providers, and to document the availability of essential anesthetic drugs and equipment in provincial, district, and mission hospitals in Zimbabwe. In this cross-sectional survey of 8 provincial, 21 district, and 13 mission hospitals, anesthetic providers were interviewed on site using a structured questionnaire adapted from standard instruments developed by the World Federation of Societies of Anaesthesiologists and the World Health Organization. The anesthetic workforce for the hospitals in this survey constituted 22% who were medical officers and 77% nurse anesthetists (NAs); 55% of NAs were recognized independent anesthetic providers, while 26% were qualified as assistants to anesthetic providers and 19% had no formal training in anesthesia. The only specialist physician anesthetist was part time in a provincial hospital. Spinal anesthesia was the most commonly used method for cesarean delivery (81%) in the 3 months before interview, with 19% general anesthesia of which 4% was ketamine without airway intubation. The mean institutional cesarean delivery rate was 13.6% of live births, although 5 district hospitals were table tilt or wedge, and insufficient blood supplies. Postoperative analgesia management was reported inadequate. This study identified areas where anesthetic provision and care could be improved. Provincial hospitals, where district/mission hospitals refer difficult cases, did not have the higher level anesthesia expertise required to manage these cases. More intensive mentorship and supervision from senior clinicians is essential to address the shortcomings identified in this survey, such as the implementation of evidence-based safe practices, supply chain failures, high

  20. Decreasing cesarean section surgical site infection: an ongoing comprehensive quality improvement program.

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    Witter, Frank R; Lawson, Patricia; Ferrell, Janis

    2014-04-01

    This report illustrates how the "plan-do-study-act" method of continuous quality improvement can be effective in reducing surgical site infection after cesarean delivery. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  1. Antibiotic prophylaxis at elective cesarean section: a randomized controlled trial in a low resource setting.

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    Kandil, Mohamed; Sanad, Zakaria; Gaber, Wael

    2014-04-01

    To determine the best time to administer prophylactic antibiotics at Cesarean delivery in order to reduce the postoperative maternal infectious morbidity in a low resource setting. One hundred term primigravidae with singleton pregnancy were recruited and randomly allocated to two equal groups. Each woman received 2 g intravenous Cefazoline. Women in Group I received it prior to skin incision while those in Group II had it immediately after cord clamping. We measured the following outcome parameters: (1) Surgical site wound infection; (2) Endometritis and (3) Urinary tract infection. There was no significant difference in any of the patients' characteristics between both groups. In Group I, three cases developed surgical site infections but four in Group II (p > 0.05). In Group I, the infected cases had Cesarean because of malpresentations while in Group II, two cases had Cesarean because of patients' request, one because of maternal heart disease and one due to intra-uterine growth restriction. Seven and nine cases had urinary tract infection in Groups I and II, respectively, (p > 0.05). Prophylactic antibiotic administration either prior to surgery or after cord clamping is probably equally effective in reducing the postoperative infectious morbidity after Cesarean in low resource settings.

  2. Outcome of Cesarean Myomectomy: Is it a Safe Procedure?

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    Senturk, Mehmet Baki; Polat, Mesut; Doğan, Ozan; Pulatoğlu, Çiğdem; Yardımcı, Oğuz Devrim; Karakuş, Resul; Tayyar, Ahter Tanay

    2017-11-01

    Myomectomy performed during cesarean section is still controversial because of the potential for associated complications, especially with large myomas. Many obstetricians avoid performing cesarean myomectomy procedures because of the risk of uncontrollable hemorrhage. However, the prevalence of pregnant women with myomas is increasing, leading to an increase in the likelihood that physicians will encounter this issue. The aim of this study was to compare outcomes and complications of patients who either had or did not have cesarean myomectomy. A total of 361 patients were evaluated in this retrospective study. Patients who had cesarean section with myomectomy and patients had cesarean section without myomectomy were compared with regard to demographics, drop in hemoglobin levels, complications, blood transfusion rates and duration of operation. These parameters were also compared when the diameter of the myoma was larger than 5 cm. Values of p  0.05), the mean myoma diameter was smaller and the duration of operation was longer in the group who underwent cesarean myomectomy (p  0.05). This study shows that myomectomy during cesarean section does not increase complications or transfusion rates and appears to be a safe procedure.

  3. Sensitive quantitative analysis of the meconium bacterial microbiota in healthy term infants born vaginally or by cesarean section.

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    Ravinder Nagpal

    2016-12-01

    Full Text Available For decades, babies were thought to be born germ-free, but recent evidences suggest that they are already exposed to various bacteria in-utero. However, the data on population levels of such pioneer gut bacteria, particularly in context to birth mode, is sparse. We herein aimed to quantify such bacteria from the meconium of 151 healthy term Japanese infants born vaginally or by C-section. Neonatal first meconium was obtained within 24-48 hours of delivery; RNA was extracted and subjected to reverse-transcription-quantitative PCR using specific primers for Clostridium coccoides group, Clostridium leptum subgroup, Bacteroides fragilis group, Atopobium cluster, Prevotella, Bifidobacterium, Lactobacillus, Enterococcus, Enterobacteriaceae, Staphylococcus, Enterococcus, Streptococcus, Clostridium perfringens, and C. difficile. We detected several bacterial groups in both vaginally- and cesarean-born infants. B. fragilis group, Enterobacteriaceae, Enterococcus, Streptococcus and Staphylococcus were detected in more than 50% of infants, with counts ranging from 105-108 cells/g sample. About 30-35% samples harbored Bifidobacterium and Lactobacillus (104-105 cells/g; whereas C. coccoides group, C. leptum subgroup and C. perfringens were detected in 10-20% infants (103-105 cells/g. Compared to vaginally-born babies, cesarean-born babies were significantly less often colonized with Lactobacillus genus (6% vs. 37%; P=0.01 and L. gasseri subgroup (6% vs. 31%; P=0.04. Overall, seven Lactobacillus subgroups/ species i.e. L. gasseri subgroup, L. ruminis subgroup, L. casei subgroup, L. reuteri subgroup, L. sakei subgroup, L. plantarum subgroup and L. brevis were detected in the samples from vaginally-born group, whereas only two members i.e. L. gasseri subgroup and L. brevis were detected in the cesarean group. These data corroborate that several bacterial clades may already be present before birth in term infants’ gut. Further, Remarkably lower detection rate

  4. Risk factors for cesarean delivery and adverse neonatal outcome in twin pregnancies attempting vaginal delivery.

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    Schachter-Safrai, Natali; Karavani, Gilad; Haj-Yahya, Rani; Ofek Shlomai, Noa; Porat, Shay

    2018-02-24

    Twin vaginal delivery presents a unique clinical challenge for obstetricians. The Twin Birth Study demonstrated the safety of planned vaginal delivery regarding neonatal outcomes. However, that study lacked a description of the risk factors associated with and the outcome of unplanned cesarean section. The aim of this study is to identify potential risk factors for cesarean section and delivery related neonatal morbidity and mortality in women with twin pregnancy attempting vaginal delivery. A retrospective cohort study including 1070 women with twin pregnancy that underwent a trial of labor between 2003 and 2015. The study population was divided according to the mode of delivery: vaginal delivery, combined vaginal-cesarean and intrapartum cesarean delivery of both twins. Several risk factors and neonatal outcomes were examined by both univariate analysis and multinomial logistic regression analysis. The rate of vaginal delivery of both twins was 88.3%, whereas the rates of combined vaginal cesarean and unplanned cesarean delivery were 4.6% and 7.1%, respectively. Nulliparity and nonvertex presentation of twin B were found to be independently associated with cesarean delivery for both twins. Additionally, nonvertex presentation of twin B was independently associated with combined vaginal-cesarean delivery. The proportion of neonates with Apgar score cesarean group compared with those delivered by the vaginal route alone. Nulliparity and nonvertex presentation of twin B were found to be associated with intrapartum cesarean delivery in twin pregnancies. © 2018 Nordic Federation of Societies of Obstetrics and Gynecology.

  5. Anesthetic management of cesarean section with mitral stenosis and respiratory tract infection

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    Madagondapalli Srinivasan Nataraj

    2014-01-01

    Full Text Available Mitral stenosis in pregnancy is poorly tolerated because of the pregnancy induced physiological changes in the cardiovascular system. Our patient had presented with cardiac failure in 5 th month of gestation due to valve area of 0.8 cm 2 . She underwent commissurotomy and was asymptomatic with valve area of 1.6 cm 2 until term when she developed lower respiratory tract infection. Anesthetic management of emergency caesarean section in this patient is discussed where neuraxial block is not well-tolerated, and general anesthesia is associated with increased morbidity in the presence of reactive airways.

  6. Effects of Recitation of Holy Quran on Anxiety of Women before Cesarean Section: A Randomize Clinical Trial

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    N Mir Bagher AjorPaz

    2012-05-01

    Full Text Available

    Background and Objectives: Anxiety is a kind of agitation and concern stemming from the feeling of threat or hazard in human. It can decrease or increase the understanding ability of individuals. Most clinical patients have anxiety in confronting a new and unknown environment such as hospitals. A non-pharmacological method such as pleasant sound of Holy Quran recitation can be used as a useful and effective procedure to decrease the anxiety. The aim of this research was to study the recitation effects of Holy Quran on anxiety of woman before cesarean.

    Methods: In this quasi-experimental study, 80 women expecting cesarean section were randomly selected regarding their characteristics and divided into two groups: control group (30 members and experimental group (50 members. Data collection instrument was a two-part questionnaire including demographic characteristics, and Spilburge’s state-trait anxiety inventory. The degree of anxiety for the two groups was evaluated before cesarean, then before innate cesarean, the Holy Quran recitation was played for experimental group for 20 minutes by the sound of famous recite, Abdol Basset. Data were analyzed using Chi-Square, single sample & paired T-test, and a Pvalue of 0<0.05 was considered as statistically significant.

    Results: The results showed that the degree of anxiety decreased in experimental group after intervention (P=0.0001, but not in the control group.(P=0.98 Comparison of the two groups showed a significant difference after intervention (P=0.002.

    Conclusion: According to the results of this research and because of the agreeable rhythmic intonation of the Quran as gnostic music and its miracle aspect, we can use its tone as a non medicinal method for reducing anxiety before cesarean women.

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

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    Fábio Farias de Aragão

    2014-09-01

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