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PubMed1980

Effect of fetal monitoring on cesarean section rates.

Electronic fetal monitoring (EFM) and cesarean sections (CS) have been studied in 14,484 patients delivered between 1970 and 1975. The primary CS rate for those monitored was 107/1000, and for the unmonitored was 57/1000. Multivariate analysis of these data shows that most of the increase in CS rate associated with monitoring is attributable to inherent differences between monitored and unmonitored patients. Furthermore, the association between monitoring and CSs was not homogeneous among sub-groups. Cesarean sections were relatively less frequent in monitored nulliparas with malpresentation and more frequent in otherwise normal monitored multiparas. These opposing effects tended to balance each other. During the study period the primary CS rate rose from 4.3 to 11.2%. This increase was strong in unmonitored patients and was primarily due to operations undertaken for fetopelvic disproportion. We cannot therefore attribute much of the increasing CS rate at our hospital to fetal monitoring.

Cesarean Section↗

PubMed1984

The course of subsequent pregnancies after previous cesarean section.

The course of pregnancies subsequent to cesarean section (CS) was studied. During the years 1970-72, 543 women were delivered by CS at Borås Central Hospital. A questionnaire was sent to all 543 during the autumn of 1976 and the spring of 1977. The questions concerned further conceptions and the outcome of all subsequent pregnancies after CS. Of the 440 (81%) women who answered the questionnaire, 244 (55.5%) became pregnant, the total number of subsequent pregnancies being 306. The incidence of spontaneous abortion, extra-uterine pregnancy and legal abortion was not significantly higher than the corresponding rate for the total material for our department during the same period. Among the 215 women who completed a new pregnancy, an elective CS was performed in 81 cases (38%). Trial of labor occurred in 143 patients, 91 of whom (68%) gave birth per vaginam , while 43 (32%) were delivered by acute CS. In nearly half of the acute CS cases the indication was a narrow pelvis not detected until labor had started. This indicates that roentgenologic pelvimetry should be considered in certain cases, when planning delivery after a previous CS.

Abortion, Spontaneous↗

PubMed1996

[Retrospective study of postoperative infectious morbidity following cesarean section].

The increase of cesarean sections produced more postoperative infections. Several authors assessed the effectiveness of chemioantibiotic prophylaxis to reduce the postoperative infective morbidity. Although the family of antibiotics more frequently used is that of cephalosporin, the best single agent has not been found yet. The aim of our study, made in the Department of Obstetrics and Gynecology of University of Naples "Federico II", is to propose a retrospective analysis concerning the incidence of cesarean section (CS), the postoperative infective morbidity and the employment of antibiotic prophylaxis. Our sample is a group of 13285 pregnant women, 3171 (23.9%) of these patients underwent to CS from 1st January 1985 to 31st December 1994. The group of 3171 women was divided in two subgroups, the first of 2748 patients un-derwent to antibiotic prophylaxis, the second of 423 was untreated due to their previous experience of allergy towards antibiotics or because there was no evidence of risk factors. The women we treated with antibiotics underwent a three days prophylactic therapy with cefazolin or ampicillin soon after the CS. The incidence of infective complications had a 21.2% rate over a total of 3171 women. Endometritis was the most common infectious complication following cesarean delivery. The rate was 53.3% in the case of primary cesarean section and 52.3% in the case of iterative cesarean section. The use of antibiotic prophylaxis gave us the opportunity to reduce the postoperative morbidity in the primary CS (23.4%) as well in the iterative CS (16.6%). On the contrary the untreated group had an infective incidence with a 33.8% rate in the case of primary CS and with a 27.4% rate in the case of iterative CS. Our opinion is that the administration of antibiotics as cefazolin and ampicillin is able to reduce in a significant way the incidence of postoperative infective morbidity as well the period of hospitalization.

Adult↗

PubMed2004

Moderate neonatal morbidity after vaginal term breech delivery.

OBJECTIVE: Comparison of the results of term breech births in our clinic with the Term Breech Trial (TBT). MATERIAL AND METHODS: During the investigation period prospective data were collected on all deliveries of a term baby in breech presentation. Some pregnant women were included in the TBT and randomized in a planned cesarean section (CS)-group and a planned vaginal birth (VB)-group. The remaining non-randomized women were divided into a primary CS-group and a started VB-group. Neonatal and maternal mortality and morbidity were analyzed retrospectively, according to the intended mode of delivery. RESULTS: Neonatal or maternal mortality occurred in none of the groups. Neither in the randomized group nor in the non-randomized group were significant differences in serious neonatal and maternal morbidity observed between the intended cesarean section-group and the group that started vaginal delivery. However, in the non-randomized group, moderate neonatal morbidity was significantly lower in the primary CS-group than in the started VB-group. CONCLUSION: The differences in moderate neonatal morbidity support the conclusion of the TBT, that primary cesarean section may be safer for the term breech baby than a trial of vaginal labor.

Adult↗

PubMed1995

Decrease in perinatal mortality and increase in cesarean section rates.

OBJECTIVES: To investigate the cesarean section (CS) rate in the Riyadh area, its trend and relationship to perinatal mortality (PNM). METHODS: Based on delivery data obtained from the Ministry of Health hospitals, Saudi Arabia, for a total of 12 years, yearly rates of CS, PNM and the ratios of obstetricians and beds per 10,000 population were computed for the Riyadh area and compared with the overall rates for Saudi Arabia. Correlation coefficients were used to investigate the relationship between the CS rate and each of the stated variables. RESULTS: Riyadh had significantly lower rates of CS and PNM than Saudi Arabia as a whole. The CS rate in Riyadh showed a positive trend (increasing from 4.4 to 6.7%) while the PNM rate revealed a significant decreasing trend (decreasing from 21.6/1000 to 16/1000 live births). A negative association existed between the Riyadh rates of PNM and CS (r = -0.2375) and PNM and the availability of obstetricians (r = -0.8693). CONCLUSIONS: From our data it was not possible to establish a cause and effect relationship between the CS and PNM rates.

Cesarean Section↗

PubMed2006

Epidural analgesia associated with low-dose oxytocin augmentation increases cesarean births: a critical look at the external validity of randomized trials.

OBJECTIVE: Randomized controlled trials suggest epidural analgesia (EA) does not increase the frequency of cesarean births compared with opioid analgesia. We analyzed trials comparing EA with opioid analgesia to determine their external validity in contemporary North American practice. STUDY DESIGN: Randomized controlled trials comparing EA with opioid analgesia were identified from the Cochrane database and Medline and included if they reported labor outcomes and management protocols. Labor management was then compared with current obstetric practice determined from surveys of North American teaching maternity units and clinical practice guidelines. RESULTS: Of 19 trials identified, 8 were included. Seven trials used Active Management of Labor protocols that used high-dose oxytocin; each demonstrated no epidural-related increase in cesarean births. One trial that used low-dose oxytocin demonstrated a marked increase in cesarean births. Most large North American obstetric units use low-dose oxytocin. CONCLUSION: Randomized trials showing no effect of EA on cesarean section (CS) rate lack external validity in much of North American practice. The limited data available suggest EA and low-dose oxytocin used together increase the CS rate. Early detection of dystocia and high-dose oxytocin augmentation should be considered for women receiving EA; those delivering in low-dose oxytocin settings should be advised of a probable increase in the likelihood of CS.

Analgesia, Epidural↗

PubMed2003

Extrusion of fetus into the abdominal cavity following complete rupture of uterus: a case report.

A gravida 10 para 9, after one Cesarean section (CS) followed by four vaginal deliveries was admitted at term without uterine contractions complaining of abdominal pain. The type of uterine scar was unknown. Severe bradycardia was observed at admission and an emergency Cesarean section was performed. A complete uterine rupture was revealed, the fetus in intact membranes and placenta were found in the abdominal cavity.

Abdomen↗

PubMed2004

Views of women towards cesarean section.

Women who deliver by cesarean section CS differ significantly from those who deliver vaginally regarding their childbirth experience. Those who deliver by CS are often less satisfied with their experience, and with themselves. They experience a feeling of resentment towards the physician, profound disappointment at the treatment expectation and loss of the happy moment of natural birth leading to postpartum depression. Cesarean delivery carries considerable disadvantages in terms of pain and trauma of an abdominal operation and complications associated with it. However, the CS rate is constantly on the rise. Hence, there is a need to evaluate the views of women undergoing cesarean deliveries and to ascertain the role of women in decision making regarding mode of delivery. This is a review of studies investigating the views of women from different countries towards CS and presents the view points of Saudi women regarding this.

Cesarean Section↗

PubMed2004

Mode of delivery in pregnancies with suspected fetal growth restriction following induction of labor with vaginal prostaglandin E2.

BACKGROUND: Many fetuses below the 10th percentile for gestational age are uncompromised. We aimed to evaluate the mode of delivery and immediate neonatal outcome in pregnancies with suspected fetal growth restriction (FGR) and normal antenatal assessment following induction of labor with vaginal application of prostaglandin E2 (PGE2). METHODS: Ninety women with suspected FGR (sonographic estimated fetal weight < 10th percentile) with normal oxytocin contraction test (OCT), biophysical profile (BPP) and reassuring fetal heart rate underwent induction of labor with vaginal application of PGE2 tablets. The findings were compared with 115 women admitted for induction of labor because of decreased fetal movement (group 2) and with 510 women with normal spontaneous onset of labor (group 3). RESULTS: There were no between-group differences in mean maternal age, gravidity, parity, nulliparity rate, number of tablets used or rate of patients receiving more than one PGE2 application. The rate of cesarean section (CS) in the study group (8.9%) was similar to the rate in groups 2 and 3 (14.8% and 9.0%, respectively). The incidence of nonreassuring fetal heart rate pattern leading to cesarean delivery was higher in the study group, but the rate of low 5-min Apgar scores (< 7) was similar in all groups. A logistic regression model and forward likelihood analysis yielded no single significant variable associated with increased risk of cesarean delivery. CONCLUSIONS: In selected cases of suspected FGR with reassuring fetal heart rate and normal OCT and BPP, induction of labor with vaginal PGE2 may yield a similar immediate fetal outcome and CS rate as in uncomplicated, induced or spontaneous deliveries.

Administration, Intravaginal↗

PubMed1990

[The importance of the prophylactic use of antibiotics with women undergoing elective cesarean section].

Postoperative infectious morbidity was described in two groups of low risk cesarean sections (CS). The frequency of postoperative infectious complications was 6.89% of women, who received penicillin for a period of 3 to 5 days, but 5.67% of women, who did not received antibiotics prophylactically. Data were presented, which showed also the economic insignificance of antibiotic prophylaxis (AP) in women with low risk CS. On the basis of the indicated data an inference was made that AP was of no clinical efficiency in women with low risk cesarean sections. The authors recommend restraint in AP of such women, in whom postoperative infectious inflammatory complications are anyway very rare.

Anti-Bacterial Agents↗

PubMed2004

Routine cesarean delivery does not improve the outcome of infants with gastroschisis.

BACKGROUND/PURPOSE: The optimal mode of delivery for infants with gastroschisis is controversial. The authors compared the outcomes of infants with gastroschisis born vaginally (VD) or by cesarean section (CS). METHODS: A retrospective analysis of infants with gastroschisis born between 1990 and 2000 was performed. Assessment included patient demographics, respiratory distress, method of closure, number of surgeries, presence of atresia, feeding parameters, parenteral nutrition days (TPN), time to full feeding (FPO), mortality, and length of stay (LOS). Subgroup analyses were performed for those infants requiring cesarean section for fetal distress. Student's t test/analysis of variance (ANOVA) or chi2/Fisher's Exact tests were used for statistical analysis. Logistic and linear regression analyses were also performed. RESULTS: One hundred thirteen patients were studied (82 VD and 31 CS). No statistical difference existed between the VD and CS groups for perinatal complications, method of closure, number of surgeries (1.6 each), TPN (40.6 v 46.0 days), FPO (40.4 v 47.1 days), mortality (9.7 v 6.5%) and LOS (53.4 v 61.7 days). CS was associated with increased stenosis (25.8 v 4.9%; P =.003), gastrointestinal dysfunction (25.8 v 11.0%; P =.049), and respiratory distress (16.1 v 3.7%; P =.035). Many of these differences did not persist when infants undergoing CS for fetal distress were excluded from the analysis. However, regression analysis identified CS as an independent risk factor for the development of respiratory distress at birth (odds ratio, 7.11; CI, 1.06 to 47.7), with a trend to increased gastrointestinal dysfunction (odds ratio, 4.35; CI, 0.77 to 24.61). CONCLUSIONS: The routine use of CS for infants with gastroschisis is not supported by our results because equivalent outcomes were observed with both modes of delivery. CS may be a necessary intervention for fetal distress.

Cesarean Section↗

PubMed1986

Continuous extraovular prostaglandin F2 alpha instillation for late pregnancy termination in patients with previous cesarean section delivery.

Late pregnancy termination by continuous extraovular instillation of prostaglandin F2 alpha (PGF2 alpha) was successfully performed in 13 patients with previous cesarean section (CS) delivery. The indications for pregnancy termination were intrauterine fetal demise in nine patients, social indications in two patients. Down's Syndrome in one patient and quadruplets pregnancy in one patient. One patient had a previous classical vertical cesarean section, two had two previous and one three previous low segment transverse (LST) cesarean sections. The other nine patients had one previous low segment transverse cesarean section. The instillation of prostaglandin solution was obtained by using a new double balloon catheter designed for extraovular pregnancy terminations. All patients aborted following the procedure with no complications. The instillation abortion time ranged from 5 1/2 to 20 h (mean 13.3 h).

Abortion, Therapeutic↗

PubMed2006

Incidence and breed predilection for dystocia and risk factors for cesarean section in a Swedish population of insured dogs.

OBJECTIVES: To estimate the incidence and breed predilection for canine dystocia using data from insurance claims. The risk factors for cesarean section (CS) were assessed for bitches with dystocia. STUDY DESIGN: Retrospective, longitudinal study. SAMPLE POPULATION: Insurance claims records (1995-2002) from a Swedish animal insurance database (Agria), including approximately 200,000 bitches. METHODS: The overall incidence rate of dystocia in insured bitches was calculated by dividing the number of reimbursed dystocia claims with the number of dog years at risk. Subsequently, incidence rates were stratified by breed, region, and habitat. The proportion of bitches with a dystocia claim that had CS were calculated, and risk factors for CS were assessed using a logistic regression model. RESULTS: Between 1995 and 2002, 3894 (2%) of 195,931 Swedish bitches included in the study had a reimbursed insurance claim for dystocia. The overall incidence rate of dystocia was 5.7 cases/ 1000 dog years at risk. Some breeds like the Scottish terrier were at increased risk of dystocia. Among bitches with dystocia, 63.8% were treated by CS. CONCLUSION: Dystocia in the bitch is more common than reported earlier. The risk of developing dystocia varies by breed, and a high percentage (63.8%) of affected bitches undergo CS. Clinical Relevance- Breeders and veterinarians could use this information to better predict which bitches are likely to experience dystocia and/or CS.

Animals↗

PubMed1983

Neonatal mortality and morbidity associated with preterm breech presentation.

A retrospective study was performed on 88 live-born preterm infants with breech presentation. The neonatal mortality (NNM) was 18.2%, and 13.3% after correction for congenital malformations incompatible with life. 62.5% were delivered vaginally, and 37.5% by cesarean section (CS). In spite of the fact that most CSs were done for indications associated with increased fetal and neonatal morbidity and mortality, overall morbidity was comparable in the two groups. Mortality was higher in the vaginal group. Entrapment of the fetal head (7.3% of vaginal deliveries) and prolapse of the cord (4.5%) were major complications of preterm breech delivery. They resulted in two cases of neonatal death (NND) and three cases of neonatal asphyxia. Prolapse of the cord was in all cases associated with footling presentation. The authors consider these results in favor of routine CS in preterm breech presentation.

Breech Presentation↗

PubMed2005

[Post-operative complications following elective and emergency caesarean delivery].

AIM OF THE STUDY: 1) To analyze the frequency of complications after elective/planned [PCS] and emergency Cesarean section [ECS]; 2) To compare the types of complications in the two evaluated groups; 3) To analyze the possible risk factors for complications after elective and emergency procedures. METHODS: The study was retrospective, hospital-based one. Data regarding complications following Cesarean section [CS] that demanded transfer of the patients to The Clinic of High Infectious Risk, State University Hospital "Maichin Dom", Sofia and prolonged hospital stay (more than 7 days after the operation) were analyzed. The incidence of complications in 574 consecutive PCS and in 292 ECS was calculated. The type of the following complications was compared in the two groups: uterine infections (endo/mio/ metrophlebitis), wound infection, subfascial hematoma, residua, sepsis, pelvic thrombophlebitis. Statistical evaluation of the results was performed by Student's t-test with p<0.05 considered statistically significant. RESULTS: In 574 PCS the frequency of postoperative complications was 1,4% while in 292 ECS it was 2,05% (p>0.05). There was not significant difference in the distribution of the different types of postoperative complications in 34 cases with PCS and 33 cases with ECS. The percentage of patients with previous CS was significantly higher in the complicated cases with PCS compared to that with ECS. The two studied groups do not differ significantly regarding the type of skin incision, operator's qualification, blood loss, drainage of the subfascial space, accompanying diseases. CONCLUSIONS: Cesarean section constitutes a major surgical procedure characterised with morbidity even if performed as a planned procedure. The risk of complications seems to be higher in cases of repeated CS. Patients that demand CS without medical indications have to be informed and be aware of these facts.

Cesarean Section↗

PubMed1997

Obstetric outcome in 100 women with severe anxiety over childbirth.

BACKGROUND: Extreme fear of delivery with request of cesarean section is a problem. The obstetric outcome in women given psychological and obstetric support is described. METHODS: Women, consecutively referred to the Psychosomatic outpatient clinic because of fear of delivery (n = 100), were compared to a matched reference group (n = 100). RESULTS: The women in the study group had higher frequency of psychic problems than the references. The majority, 68 of the women (68%) initially requested cesarean section (CS). After individualized psychological and obstetrical support, 38 of these women agreed to vaginal delivery (38%) and 30 had an elective CS (30%). In the end another 13 (13%) women had a CS for obstetric or mixed reasons. Complication rate was low and similar in the groups. The 57 women who eventually had a vaginal delivery (57%) showed an obstetric outcome similar to the reference group. They had a higher frequency of induction of labor (p = 0.02). and of epidural and pudendal blocks for pain relief (p = 0.002 and 0.05 respectively). They had shorter labor time (p = 0.05). The cost of the psychological therapy was well compensated for by the savings due to the reduction in the number of CS. CONCLUSIONS: Psychosomatic support for women with severe fear of delivery resulted in a 50% reduction of CS for psychosocial indications and vaginal deliveries similar to a reference group. The cost of psychosomatic support was less than savings due to fewer cesarean sections.

Adult↗

PubMed2001

[Diagnosis and treatment of pulmonary embolism during pregnancy].

OBJECTIVE: To study high risk factors, clinical presentation, diagnosis and treatment of pulmonary embolism (PE) during pregnancy and postpartum. METHODS: Two patients with pulmonary embolism were reported retrospectively. RESULTS: The 1st case was a pregnant woman with congenital heart disease at 39 weeks gestation, who underwent uneventful cesarean section (CS) because of heart disease, but she had tachycardia, tachypnea, cyanosis, dyspnea suddenly on the 10 days after CS and died immediately after the onset of above symptoms, the diagnosis of PE was highly suspected clinically. The 2nd case was a pregnant women with twin gestation, at 35 weeks, because of severe prenatal myocardiopathy, cesarean section was performed, Maternal death occurred suddenly during the surgery. The diagnosis of PE was confirmed by autopsy. CONCLUSIONS: The maternal mortality of PE during pregnancy and postpartum is very high, whenever there is any suspects, the objective examination for PE should be started early in order to get the chance to give anticoagulant therapy.

Adult↗

PubMed2002

Pulmonary embolism during pregnancy and the postpartum period: report of 2 cases.

OBJECTIVE: To investigate the high risk factors, clinical features, diagnosis and treatment of pulmonary embolism (PE) during pregnancy and the postpartum period. METHODS: Two cases of PE during pregnancy and postpartum period were reported retrospectively. RESULTS: The first case was a pregnant woman with congenital heart disease at 39-week gestation. She underwent a successful cesarean section (CS) because of heart disease, but she manifested tachycardia, tachypnea, cyanosis, and dyspnea suddenly on the 10th day after CS and died soon after the onset of these symptoms. The diagnosis of PE was highly suspected clinically. The second case was a twin-pregnancy woman at 35-week gestation. Because of severe perinatal myocardiopathy, cesarean section was performed. Unfortunately, the patient died abruptly on the operation table. The diagnosis of PE was confirmed by autopsy. CONCLUSIONS: The maternal mortality of PE during pregnancy and postpartum period is quite high. Whenever there is any doubt, objective examinations for PE should be started early in order to strive for the chances of the anticoagulant therapy.

Adult↗