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PubMed1983

Prolapse of the cord: reduction of perinatal mortality by bladder instillation and cesarean section.

The fetal outcome in 135 cases of cord prolapse seen during the period 1970-79 was studied. The fetus was alive at diagnosis in 127 cases. In 88 (69.3%) of the cases, the cord prolapsed during the first stage of labor and they were managed by Vago's method of rapid instillation of saline into the bladder to relieve cord pressure during preparation for cesarean section (CS). In the remaining 39 cases, the cord prolapsed during the second stage of labor and the patients were delivered vaginally. The overall perinatal mortality rate was 8.1%. The perinatal mortality rate among cases with a live fetus at diagnosis was 2.4%. In spite of a long diagnosis-delivery interval, no fetal deaths occurred in the 88 cases managed by bladder instillation and CS. Vaginal delivery of footling presentations was associated with a fetal mortality of 18.2%. The infant depression rate was significantly higher in breech vaginal deliveries than in CSs (P less than 0.001). Fetal bradycardia at the time of diagnosis was associated with an increased infant depression rate following vaginal delivery (39%) as compared with CS (10%). The CS rate in this series is the highest and the perinatal mortality among the lowest yet reported.

Cesarean Section↗

PubMedDate not supplied

Effect of morphine-diazepam on signs of anesthesia, awareness, and dreams of patients under N2O for cesarean section.

Morphine (0.2 mg/kg) and diazepam (0.1 mg/kg) were injected IV after delivery of the fetus in 68 parturients undergoing cesarean section (CS). General anesthesia was with thiamylal-N2O-O2 (4:2) and muscle relaxant. Twenty-four to 36 hours postoperatively, 1 patient had recall, 1 had unpleasant dreams, and 2 had pleasant dreams. The incidence of recall and unpleasant dreams was 3.8 percent in elective CS and 0 percent in emergency cesareans. Morphine-diazepam combination caused anterograde and retrograde amnesia. During the cesarean, movement of patient, size of pupils, or changes in blood pressure were not indicative of awareness or dreams. During anesthesia, 33 percent O2 produced adequate oxygenation of mother and fetus.

Amnesia↗

PubMed1990

[Outcome of the mother and baby delivered by cesarean section in pregnancy induced hypertension. Analysis of 487 cases].

We analyzed the outcome of mother and baby in 487 cases of pregnancy induced hypertension (PIH) delivered by Cesarean section (CS). The indication for CS in 70 cases was simply PIH (14.4%) and 6 out of 9 antepartum eclampsia had CS. There was no maternal or fetal death. The authors suggest that CS should be done whenever eclampsia could not be put under control in order to save both mother and baby. The incidence of postpartum hemorrhage (PPH) was lower in the CS group than in the vaginally delivered group. No late PPH occurred in our CS cases. The incidence of IUGR was 30.4%. Of these IUGR cases 43 were delivered by CS. No stillbirth occurred. The number of neonatal anoxia was less than in the vaginally delivered group (P less than 0.10).

Cesarean Section↗

PubMed2005

Uterine leiomyoma among women who conceived following fertility treatment.

OBJECTIVE: The objective was to determine if uterine leiomyoma increases the risk of cesarean section (CS) among women who conceived following fertility treatment. STUDY DESIGN: The study population consisted of all women who conceived after fertility treatment with singleton gestation and who delivered between the years 1988 and 1999 in the Soroka University Medical Center. A comparison was performed between patients with and without uterine leiomyomas. The Mantel-Haenszel procedure was used to obtain the weighted odds ratio (OR) for CS, while controlling for confounding variables. RESULTS: During the study period 1,995 women conceived following fertility treatment. Of these, 63 patients had uterine leiomyomas (3.2%). Women treated for fertility with uterine leiomyomas had statistically significant higher rates of CS than those without uterine leiomyomas (61.9% vs. 28.1%, OR=4.2, 95% CI 2.4-7.2; P<0.001). Stratified analysis (the Mantel-Haenszel technique) was used to control for possible confounders, such as gestational diabetes, hypertensive disorders, maternal age, failure of labor to progress, placental abruption, malpresentation, hydramnios, oligohydramnios, and a previous CS. None of those variables changed the significant association or explained the higher incidence of CS in the uterine leiomyoma group. CONCLUSIONS: Uterine leiomyoma is an independent risk factor for CS among women who conceived following fertility treatment.

Abruptio Placentae↗

PubMed1997

Induction of labor by intracervical prostaglandin gel and oxytocin infusion in primigravid women with unfavorable cervix.

The rate of Cesarean Section for failed induction of labor and maternal and fetal compilations are high when labor is induced in a nulliparas women with an unripe cervix by amniotomy and oxytocin infusion. Prostaglandins (PG) in different forms have been used for ripening the cervix with an aim of reducing these problems. A prospective randomized trial was performed on one hundred primigravid women between 37 and 42 weeks of gestation with singleton pregnancy, cephalic presentation and unfavorable cervix (Modified Bishop Score < or = 5) in the department of Obstetrics & Gynaecology of Institute of Postgraduate Medicine & Research from 1st May 1996 to 30th April 1997. In this study the efficiency of prostaglandin E2 intracervical (PGE2 IC) gel in induction of labor in a group of primigravid women with unripe cervix was assessed and compared with another group with similar characteristics using oxytocin infusion and artificial rupture of membrane (ARM). The Modified Bishop Score (MBS), interval between IOL and onset of labor and the duration of labor after insertion of PGE2 gel was significantly different from those of oxytocin infusion group. But the Apgar Score at 1 & 5 min had shown no statistically significant difference. Any significant difference could also not be detected in the mode of delivery between the two induction group. The proportion of emergency Cesarean Section (CS) was high in the oxytocin infusion group than that of in the prostaglandin group. There was also no significant difference regarding the acceptability of both the induction methods.

Adult↗

PubMed1999

Anesthesia for cesarean section and acid aspiration prophylaxis: a German survey.

UNLABELLED: We surveyed routine anesthetic practice and measures to prevent acid aspiration syndrome (AAS) in patients undergoing cesarean section (CS) throughout Germany. Of 1061 questionnaires, 81.9% were returned. For scheduled CS, general anesthesia was used in 63% of cases, and for urgent CS, it was used in 82% of cases. Regional anesthesia was used less often for both scheduled and urgent CS in smaller (< or =500 deliveries/yr; 28% and 16%, respectively) than in medium-sized (500-1000 deliveries/yr; 42% and 19%, respectively) or major obstetric departments (>1000 deliveries/yr; 45% and 21%, respectively). Among the regional techniques, epidural anesthesia (59%) was preferred more than spinal anesthesia (40%) in scheduled CS. In urgent CS, spinal anesthesia predominated (56% vs 42%). Pharmacological AAS prophylaxis is routinely used in 69% (68%) of departments before elective (urgent) CS under general anesthesia and in 52% under regional anesthesia. H2-blocking drugs are preferred for AAS prophylaxis over H2-blocker plus sodium citrate and sodium citrate alone. Both the incidence of and the mortality from AAS at CS are very low in Germany (<1 fatality per year). Nevertheless, AAS prophylaxis deserves more widespread use in obstetric anesthesia and in other patients at risk (e.g., children, outpatients). IMPLICATIONS: According to a countrywide survey, the use of regional anesthesia for cesarean section and pharmacological prophylaxis of acid aspiration syndrome is considerably less common in Germany than in the United States, United Kingdom, or other European countries.

Anesthesia, Conduction↗

PubMed1994

[Trial vaginal delivery for women with previous cesarean section].

A retrospective analysis was made on 85 cases of trial labor after previous cesarean section (CS) and compared with 100 primiparous vaginal deliveries (as control) during the last 10 years. Oxytocin infusion has been used in 61 trial cases to induce and/or to accelerate labor, and valium, procaine and atropine administered during the labor process in 23 of them. 65 of the 85 cases (76.5%) successfully delivered through the vagina (VD group), while 20 cases (23.5%) had repeat CS following failure in trial labor (CS group), and 3 women had reatened uterine rupture. There was 1 neonatal death in the VD trial labor group. No obvious difference in the Apgar scores of newborns was found between the CS group and the controls, and the duration of the labor process was much shorter in the VD trial group than that in the primiparae (7.51 +/- 2.44 hrs vs. 9.10 +/- 3.75 hrs) (P < 0.01). This study indicated that following a previous uneventful transverse lower segment cesarean section, trial labor should be encouraged under supervision.

Adult↗

PubMed2001

Prospective, randomized, comparative study of Misgav Ladach versus traditional cesarean section at Nazareth Hospital, Kenya.

Cesarean section (CS) is the commonest major operation carried out in many low income countries. A new technique for CS, called the Misgav Ladach procedure, was evaluated in a randomized trial in Nazareth Hospital (Kiambu District, Kenya). A total of 160 patients were assigned to the Misgav Ladach procedure (n = 80) or to the traditional CS as performed in most rural hospitals in low income countries (n = 80). The two groups were analyzed by operating time, presence of infection and febrile morbidity, grade of postoperative pain, starting of fluid and solid alimentation, and development of incisional hernia and hypertrophic scar. The operating time of the Misgav Ladach procedure was significantly shorter. 20.4 (SD 6.1) minutes versus 30.4 (SD 6.1) minutes (p < 0.001). A total of 5 wound infections (6.2%) were seen with the Misgav Ladach procedure versus 16 (20.0%) in the control group (p = 0.01). The number of analgesic doses required during the postoperative period were significantly less in the Misgav Ladach group: 1.3 (SD 0.6) versus 1.9 (SD 0.7) ampuls of pethidine (p < 0.001) and 15.1 (SD 2.0) versus 16.4 (SD 1.8) tablets of ibuprofen (p < 0.001). Incisional pain was significantly less in the Misgav Ladach group: Visual Analogue Scale score 3.0 (SD 1.5) versus 4.9 (SD 2.0), p < 0.01. The patients in the Misgav Ladach group began drinking fluids voluntarily [19.1 (SD 4.5) hours versus 20.6 (SD 4.0) hours; p = 0.01] and eating solid food [41.2 (SD 9.3) hours versus 46.1 (SD 9.0) hours; p < 0.01] significantly before than those in the control group. At the 6-week follow-up, the presence of hypertrophic scar was significantly associated with the traditional procedure (2.1% vs. 48.8%; p < 0.001). We conclude that the Misgav Ladach operation should become the standard method for performing CS in low income countries, particularly in rural hospitals.

Adult↗

PubMed1991

Cesarean section in Kuwait, 1983 through 1988.

Examination of the cesarean section (CS) rate at the Ministry of Public Health hospitals in Kuwait during 1983 through 1988 revealed a rate of 9.36% and showed no significant trend. The rates in the individual 4 hospitals differed significantly. A significant weak positive correlation between the CS rate and instrumental delivery rates was found. No significant correlation was found between the CS rate and perinatal mortality rate, but a weak positive correlation was found between the CS rate and neonatal mortality rates. Based on the existing health information system in Kuwait, it was not possible to determine whether variations in CS rates were secondary to differences in the risk status of the population subgroups, or were related to physicians' practice style which offers a potential for reduction of the higher rates. Deficiencies identified in the existing health information system included unavailability of information about parity, indications of CS, and whether the procedure was a primary or repeat one. Recommendations to rectify these deficiencies were suggested.

Adolescent↗

PubMed2005

Cesarean section, gestational age, and transient tachypnea of the newborn: timing is the key.

The purpose of this study was to identify risk factors and to characterize infants with transient tachypnea of the newborn (TTN). A total of 67 newborns with TTN, born at gestational age (GA)>or=35 weeks, were studied. Newborns delivered before and after each study case served as controls. Mean GA was lower and cesarean section (CS) rate was higher in the TTN group (38.2+/-2.3 versus 39.5+/-1.4 weeks, p<0.001; 50.7% versus 22.4%, p<0.001). GA<38 weeks was found to be associated with increased risk for TTN in infants delivered by elective CS. TTN was associated with significant morbidities and longer hospital stay (7.2+/-5.6 versus 2.9+/-1.4 days; p<0.001). Delivery by CS and younger GA are risk factors for TTN. Although TTN is a self-limited disease, it is associated with significant morbidities. Scheduling elective CS at GA of not less than 38 weeks may decrease the frequency of TTN.

Cesarean Section↗

PubMed2001

Use of inhaled nitric oxide for emergency Cesarean section in a woman with unexpected primary pulmonary hypertension.

PURPOSE: Use of inhaled nitric oxide (iNO) could be of importance in emergency cases of primary pulmonary hypertension (PPH) in pregnant patients during labour and delivery. iNO acts as a selective pulmonary bed vasodilator avoiding systemic hemodynamic effects due to its ease of administration. Pulmonary bed vasodilation improves right ventricular function directly and left ventricular function indirectly. CLINICAL FEATURES: We report the case of a pregnant patient with unexpected PPH in whom an emergency Cesarean section (CS) had to be performed. PPH was diagnosed on admission as she arrived in active labour at 34 weeks gestational age. An emergency CS was performed under epidural anesthesia for breech presentation . All along labour, delivery and the first 24 hr, iNO was administered via a noninvasive ventilation device. CS was uneventful. A severe pulmonary hypertensive crisis was observed 12 hr after delivery and resolved with an increase of iNO concentration and administration of isoprenalin. The patient and baby returned home on day ten. CONCLUSION: The ease of administration of iNO allowed the optimal control of pulmonary arterial hypertension. No interaction with epidural anesthesia was observed. Use of iNO can improve the management of urgent CS in women with unexpected PPH.

Administration, Inhalation↗

PubMed2004

Indicated labor induction with vaginal prostaglandin E2 increases the risk of cesarean section even in multiparous women with no previous cesarean section.

AIMS: To evaluate the impact of induction of labor with vaginal tablets of prostaglandin E2 on the rate of cesarean section (CS), and to identify possible predictors of successful vaginal delivery. METHODS: 1541 consecutive women admitted for induction of labor with vaginal tablets of PGE2 were retrospectively compared with 574 consecutive women with spontaneous onset of labor. RESULTS: Maternal age, nulliparity, previous CS, gestational age, and birth weight were similar in the study and control groups. The CS rate was twofold higher in the study group (20.7% vs 10.6%). CS rates in the study and control groups were 26.9% and 12.8% for the nulliparous women, and 11.2% and 5.1% for the multiparous women with no previous CS. Neither group had major maternal or fetal complications. A logistic regression model and stepwise analysis showed that nulliparity, previous CS, maternal age, number of PGE2 applications, birth weight, and the induction of labor by itself were independent significant risk factors for increased CS rate. CONCLUSIONS: Induction of labor with vaginal PGE2 tablets results in a vaginal delivery rate of 79.3%, with apparently no serious maternal or fetal complications. Nulliparity, and previous CS are the most significant risk factors for increased CS rate. However, even after these risk factors are excluded and controlling for possible predictors for CS, PGE2 induction is independently associated with a twofold increase in CS rate, most often because of labor dystocia.

Administration, Intravaginal↗

PubMed1985

X-ray pelvimetry and trial of labor after previous cesarean section. A prospective study.

The benefits of X-ray pelvimetry and electronic monitoring of fetal heart rate and intra-uterine pressure were studied prospectively in order to predict the likelihood of a successful vaginal birth after previous cesarean section (CS). In 1982, a total of 369 parturients (7% of all deliveries) who had previously undergone CS were studied. Trial of labor (TL) was allowed in 160 cases (43.4%) and planned repeat CS was performed in 209 patients (56.6%). Patients in the TL group were compared with a matched control group. One hundred and fifty patients (94%) in the TL group gave birth by the vaginal route. There were no differences in the duration of the first and second stage of labor, duration of ruptured membranes (ROM), maternal blood loss or the incidence of CS and vacuum extraction between the TL group and the control group. Rates of low Apgar score (less than 7) at 1 and 5 min were the same in both groups. Intensive fetal monitoring during the course of labor, together with X-ray pelvimetry in selected cases, markedly reduced the incidence of acute repeat CS with no change in the overall rate of successful vaginal delivery compared with our previous results.

Cesarean Section↗

PubMed1993

Higher white blood cell counts and band forms in newborns delivered vaginally compared with those delivered by cesarean section.

The authors retrospectively reviewed complete blood counts in the medical records of all babies admitted to a normal newborn nursery from January through December 1989. The subjects consisted of 326 babies who were delivered vaginally (VgD) and 138 who were delivered by Cesarean section (CS). All blood samples were drawn by warmed or unwarmed heel sticks or by venipuncture. The subject's age at the time of blood drawing was similar in both VgD and CS groups (13.4 vs. 13.9 hours, P = 0.51). The number of total leukocytes, neutrophils, band forms, and platelets was significantly higher in VgD newborns than in CS newborns. The mean and standard error of the mean for each of these blood counts (each per microliter) were 23.9 x 10(9) +/- 0.33 versus 21.1 x 10(9) +/- 0.6, 14.6 x 10(9) +/- 0.26 versus 12.8 x 10(9) +/- 0.39, 1.18 x 10(9) +/- 0.08 versus 0.82 x 10(9) +/- 0.08, and 304 x 10(9) +/- 4.1 versus 286 x 10(9) +/- 0.6, respectively (P values for the first three comparisons were all less than 0.005). However, there was no difference between the two groups with regard to hemoglobin, hematocrit, and absolute number of lymphocytes, eosinophils, basophils, and monocytes (P > 0.5). It was speculated that the higher leukocyte, neutrophil, and band counts in VgD babies are the consequences of physical stress and periodic hypoxia, which are more frequent and prolonged with VgD compared with CS delivery. The authors suggest that the mode of delivery should be considered when interpreting blood counts in neonates.

Cesarean Section↗

PubMed1999

[Measurement of boundary line of urinary bladder and peritoneum in abdominal wall and the application in performing cesarean section with urinary bladder reversal method].

OBJECTIVE: To provide the basic research data and clinical application in performing extraperitoneal cesarean section (CS) with urinary bladder reversal method. METHODS: The position and the surface projection of the vesico-peritoneal fold and the apex of the urinary bladder were measured in 107 cases of term pregnant women (37-42 weeks, aged 20-40). RESULTS: The distance from the bladder apex to the umbilicus and to the symphysis pubis were (14.1 +/- 3.4) cm and (6.8 +/- 1.4) cm respectively, while from the utero-vesical pouch to umbilicus and symphysis pubis were (15.8 +/- 3.9) cm and (4.9 +/- 1.5) cm respectively. During late pregnancy the projection of bladder apex was located at the point between the middle and the lower 1/3 of the line from umbilicus to symphysis pubis; while the utero-vesical pouch was located at the point between upper 3/4 and the lower 1/4 of the same line. The time interval from the start of operation to the delivery of baby was (14.56 +/- 6.3) min, and the total operation period was (45.5 +/- 9.3) min. The largest baby weighed 5,050 gm and there was no bladder injury. CONCLUSION: To define the position of vesical peritoneal fold would give benefit to the extraperitoneal CS with bladder reversal method which was performed under direct visualization and could avoid injury of bladder.

Adult↗

PubMed1991

International collaborative effort (ICE) on birth weight, plurality, perinatal, and infant mortality. IV. Differences in obstetrical delivery practice: Norway, Scotland and the United States.

We have carried out a comparative study on differences in operative obstetrical practice during the 1970s and 1980s, in Norway, Scotland and the United States of America. It was based on information from official sources in each country. We compared rates of cesarean section (CS) and operative vaginal delivery according to maternal age, parity and gestational age at delivery, birthweight, fetal presentation, and other characteristics of the child, indications for operative delivery, and hospital size and teaching status. While all three countries had rising CS rates, the Scottish rates, which lay between those of the U.S.A. and Norway, rose more slowly than in the latter. In 1985, the rates were 22.8% in the U.S.A., 13.5% in Scotland and 12.0% in Norway. Use of forceps and vacuum extractor declined in the U.S.A. and Scotland, but increased in Norway. CS rates in mothers aged 35 and over were uniformly high in 1970 and rose relatively little. Specific CS rates for very low birthweight children, breech presentation and twins rose to 30-50% in all three countries with some national trend differences. Rate ratios of operative delivery between large and small hospitals fell from about 2-3 in the 1970s to approximately 1.5 in 1985, least markedly in Scotland. The impact of previous CS as an indication for CS cannot be resolved because of notification and recording differences.

Adult↗

PubMed1989

Cesarean section does not improve outcome in gastroschisis.

Elective cesarean section (CS) following prenatal diagnosis of gastroschisis has been advocated to decrease morbidity and mortality. To examine this hypothesis, we reviewed the records of 28 consecutive patients with gastroschisis treated between 1975 and 1987. Fourteen infants were delivered vaginally (V) and fourteen by CS, of which seven were elective, five were for fetal distress, and two were for breech presentation. Prenatal diagnosis was made in nine infants in the CS group and none in the vaginal group. The two groups were comparable in gestational age (V = 37.6 weeks, CS = 35.8 weeks, P = .05), birth weight (V = 2,508 g, CS = 2,444 g, P = NS), and five-minute Apgar score (V = 7.8, CS = 6.8, P = NS). Outcome was similar as measured by hospital mortality (V = 0/14, CS = 1/14, P = NS), complications (V = 4/14, CS = 5/14, P = NS), days to enteral feeding (V = 14, CS = 19, P = NS), and days in the hospital (V = 27, CS = 34, P = NS). The only complication related to mode of delivery was preventable; an infant delivered vaginally had avulsion of a short segment of mesentery requiring bowel resection. Infants born by CS were slightly more likely to have primary closure (5/14) than babies delivered vaginally (3/14, P = NS), but this may reflect independent trends in the last 5 years. Elective CS following prenatal diagnosis in seven patients did not improve outcome; primary closure was achieved in only one infant, and three had a complication. Since these data show no significant difference in morbidity and mortality between vaginal and CS delivery, we suggest that CS should not be recommended simply because a prenatal diagnosis of gastroschisis is made.

Abdominal Muscles↗

PubMed1981

Epidural morphine for the control of pain after cesarean section.

Epidural morphine was evaluated for the control of postoperative pain after cesarean section (CS). Sixty-five patients undergoing elective CS with epidural bupivacaine were studied. Of these, 40 were given a single dose of 4 mg of morphine through an epidural catheter on termination of surgery. The remaining 25 patients received no postoperative epidural medication. In all cases, the catheters were withdrawn before the patients left the operating theater and 15 mg doses of papaveretum (OMNOPON) ordered as required for pain relief. The ward staff was unaware of the study. The time between the termination of surgery and the first administration of postoperative narcotic was noted, as was the total dose, for 48 h. The epidural morphine was associated with a prolonged period of postoperative analgesia and a greatly reduced total papaveretum requirement for the 48 h (30.9 mg for the study group in contrast to 67.6 mg for the controls). The difference between the two groups was significant (P less than 0.001). We concluded that epidural morphine is an efficient method for the control of postoperative pain following CS, a single dose of 4 mg providing relief from pain for 8 to 12 h and sometimes longer.

Cesarean Section↗