BACKGROUND: Pain management following caesarean section still remains a challenge in our environment. Most potent analgesics are either not readily available or expensive. Diclofenac suppository is an NSAID that can b...BACKGROUND: Pain management following caesarean section still remains a challenge in our environment. Most potent analgesics are either not readily available or expensive. Diclofenac suppository is an NSAID that can be used for postoperative analgesia. It is available and affordable. OBJECTIVE: To compare the efficacy and safety of combined rectal diclofenac and intramuscular pentazocine with intramuscular pentazocine alone for post operative pain control following lower segment caesarean section. METHODOLOGY: A total of 120 women who met the selection criteria scheduled for caesarean section under spinal anaesthesia with bupivacaine were randomized into two equal groups to receive either 75 mg diclofenac suppository 12 hourly for 24 hours or one anusol suppository (the placebo) 12 hourly for 24 hours. Both groups received pentazocine as primary analgesia. RESULT: The primary outcome measure is the proportion of patients with severe pain at 24 hours using the visual analogue rating scale. Secondary outcome measures are the time from surgery to ambulation, Passage of flatus, maternal satisfaction and presence of complications. Statistical analysis was done using spss version 22 and graph pad statistical package. Student T-test was used for continuous variables whereas chi square was used for categorical variables P CONCLUSION: Adjuvant rectal diclofenac is superior to pentazocine alone in the management of pain after caesarean section. Less number of patients had moderate to severe pain at 24 hours post operation. Maternal satisfaction in relation to pain management is better with diclofenac suppository. The levels of complications were comparable in both groups.展开更多
Background: The myometrium at the location of the CS (caesarean section) scars, also known as residual myometrium thickness (RMT), is larger after a double-layer uterine closure procedure than following a single-layer...Background: The myometrium at the location of the CS (caesarean section) scars, also known as residual myometrium thickness (RMT), is larger after a double-layer uterine closure procedure than following a single-layer one. It may lessen the formation of a niche that is the myometrium’s disruption at the location of the scar of the uterus. Gynecological manifestations, obstetric problems in a future pregnancy and birth, and maybe subfertility are linked to thin RMT and a niche. Objective: To ascertain if double-layer unlocked closure of the uterus is better than single-layer one in terms of post-menstrual spotting and niche development following a first CS. Patients and Methods: In this randomized clinical study, 287 patients were evaluated for qualifying. Of all eligible individuals, 57 patients were excluded from the study based on the inclusion criteria. Results: The variation in ages, gestational age, body mass index (BMI), and cesarean section indications between the two assigned groups is statistically insignificant. However, postmenstrual spotting was statistically significantly more common in single-layer group compared to in double-group. The current study revealed ultrasound findings suggestive of niche formation was statistically significantly more common in single-layer group compared to in double-layer group. Conclusion: As evident from the current study, it demonstrates the advantages of double-layer unlocked closure of the uterus over single-layer one in terms of post-menstrual spotting and niche development following first-time cs. Thus, we deduced that fewer niches are formed, and fewer menstrual spotting occurs in the presence of double unlocked layers closure. To ascertain the impact of uterus closure method on post-operative niche development and the risk of obstetrics and gynaecological problems, further prospective trials with extended follow-up periods are required.展开更多
BACKGROUND For the past few years,preventive interventional therapy has been widely used domestically and overseas,bringing great benefits to pregnant women at high-risk for complications,such as pernicious placenta p...BACKGROUND For the past few years,preventive interventional therapy has been widely used domestically and overseas,bringing great benefits to pregnant women at high-risk for complications,such as pernicious placenta previa(PPP)and placenta accreta.Nevertheless,there are still few reports on surgical complications related to interventional therapy,and its safety should be a concern.CASE SUMMARY We report a 36-year-old pregnant woman with PPP who underwent balloon implantation in the lower segment of the abdominal aorta before caesarean section.However,the balloon shifted during the operation,which damaged the arterial vessels after filling,resulting in severe postpartum haemorrhage in the patient.Fortunately,after emergency interventional stent implantation,the pa-tient was successfully relieved of the massive haemorrhage crisis.CONCLUSION It seems that massive postoperative bleeding has been largely avoided in preventive interventional therapy in high-risk pregnant women with placenta-related diseases,but surgical complications related to intervention therapy can also cause adverse consequences.It is equally important for clinical doctors to learn how to promptly identify and effectively treat these rare complications.展开更多
Context: The caesarean section rate continues to increase in our different health structures specially for women who have not had a scar in the uterus. Objectives: The aim of this study was to analyze the key factors ...Context: The caesarean section rate continues to increase in our different health structures specially for women who have not had a scar in the uterus. Objectives: The aim of this study was to analyze the key factors and main indications for primary caesarean sections and to find ways to reduce the increasing rates. Patients and Method: This is a longitudinal and retrospective study carried out from June 1, 2018 to July 31, 2022. The study included all patients who had a cesarean-section for the first time (primary caesarean). An anterior uterine scar was a non-inclusion criterion. Data were collected prospectively using Synfonievre and Agopra software via patients’ files and information collection sheet. Data were analyzed with SPSS 21 software, Mac version. Averages were calculated for quantitative data and percentages for qualitative data. The statistical tests used were the Pearson Chi<sup>2</sup> test. The observed differences were considered significant when the p-value was less than 0.05. Results: During the study period, we recorded 8832 deliveries and 3148 caesarean sections (35.6%). Primary CS concerned 70% of overall C-section rate. The main indications were FHR Fetal Heart Rate abnormalities (FHRA) (27%), followed by the other indications (including preterm delivery, umbilical cord dystocia, malpresentation of fetus, foetal abnormalities, elective CS, triple gestation, mother abnormalities);dystocia or prolonged labor (18.7%), breech presentation in a twin pregnancy with 11.3% and 9.6% respectively. We recorded more vaginal deliveries with labor induction: 81.4% against 75.2%. An obstetrical audit led to better labor management and a reduction in the cesarean section rate. Conclusion: We need to focus on diagnosis of fetal distress, management of breech presentation during of a twin birth and a singleton. Induction of labor can be an effective alternative in certain indications. An obstetrical audit is needed to reverse the caesarean section rate.展开更多
Background: Blood loss during caesarean section (C/S) may lead to postpartum haemorrhage, and is one of the direct causes of maternal mortality and morbidity globally. Tranexamic acid is recommended in the treatment o...Background: Blood loss during caesarean section (C/S) may lead to postpartum haemorrhage, and is one of the direct causes of maternal mortality and morbidity globally. Tranexamic acid is recommended in the treatment of postpartum haemorrhage (PPH) if oxytocin and other utertonics are ineffective in controlling PPH. In this centre it is not used prophylactically to reduce blood during caesarean section. Aim: To assess the effect of prophylactic intravenous tranexamic acid on blood loss during and after elective C/S at the University of Port Harcourt Teaching Hospital (UPTH). Methods: This was a prospective, single-blind, randomized, placebo-controlled interventional study conducted at the Obstetric theatre of UPTH from July 2020 to March 2021. Eligible women were randomized into two groups;seventy-two women received intravenous tranexamic acid while seventy-one women received a placebo. Socio-demographic data and the result of the study were collected through a proforma. Data collected was analyzed using Statistical Package for Social Sciences (SPSS) Version 22.0. The results were expressed in tables and charts as frequencies, percentages and mean. Chi-square test, Fisher’s exact, and T-test were used to determine the relationship between variables. P-value ≤ 0.05 was considered statistically significant. Results: The findings showed that tranexamic acid significantly reduced mean blood loss during and after C/S (p-value post-surgery was significantly lower in the tranexamic acid group (624.88 ± 200.76 ml) in comparison to the placebo group (864.24 ± 229.09 ml), p-value = 0.001. The mean post-C/S packed cell volume (PCV) was significantly higher among the tranexamic acid group (30.68% ± 2.80%) in comparison to the placebo group (28.07% ± 3.27%), t = 5.131, p-value = 0.0001. The maternal side effects were nausea and vomiting, 9 (12.5%) and 1 (1.4%) participants respectively. Conclusion: Tranexamic acid significantly reduced blood loss during and after elective C/S. Maternal side effects were less with tranexamic acid use.展开更多
Background: The caesarean section rate is an important factor that characterizes the effectiveness of the obstetric service. The large variability of the initial state of women in labor and the variety of indications ...Background: The caesarean section rate is an important factor that characterizes the effectiveness of the obstetric service. The large variability of the initial state of women in labor and the variety of indications for surgery does not allow us to identify the main determinants. We attempted to determine and analyzed the first data on the structure and frequency of caesarean section in Armenia in the hospital of the Erebоuni multidisciplinary clinic before the introduction of the M. Robson scale. Methodology: We conducted a retrospective study of the history of childbirth in 38,111 patients registered at the Erebouni Medical Center for the period 2016-2021. The materials of the study were case histories, hospitalization materials and annual reports. Results: According to the obtained data, 80.5% of caesarean section operations were performed as planned. Only 14% of pregnant women were delivered by caesarean section according to absolute indications, the frequency of that in this maternity hospital increased from 36.77% to 44.95% over the analyzed period Conclusion: Thorough psychoprophylactic preparation of pregnant women for childbirth, including those with a scar on the uterus after a previous cesarean section, can ensure a steady desire of women in labor for vaginal delivery, full mobilization of their own capabilities, and more trusting cooperation with medical staff.展开更多
Caesarean section (CS) is a surgical procedure performed to remove a fetus from the mother’s uterus through an incision on the abdominal wall, then on the uterine wall. The indications of CS vary not only between cou...Caesarean section (CS) is a surgical procedure performed to remove a fetus from the mother’s uterus through an incision on the abdominal wall, then on the uterine wall. The indications of CS vary not only between countries, but also from one hospital to another and from one team to another within the same hospital. Despite advances in asepsis and anesthesia/resuscitation technics, there are still complications of varying severity inherent to the gravid-puerperal state on one hand and the technics used on the other, irrespective of the operative indication. Thus, the present study was carried out with the objectives of determining the prevalence, identifying the indications, and evaluating the morbidity linked to caesarean sections in our environment. Cameroon has also set up a health voucher program in its northern region, aimed at reducing maternal and fetus morbidity and mortality. The program aims to improve financial access in antenatal care and deliveries, including caesarean sections, in this low-income region of the country. We conducted a descriptive cross-sectional study with retrospective data collection, from February 1, 2022, to May 31, 2022. We included all women who gave birth by caesarean section. In our study series, out of 905 parturient admissions into the Department of Obstetrics and Gynecology, 226 were caesarian cases. The overall frequency of CS during our study period was 25%. Fetal indications were dominated by cephalopelvic disproportion and non-reassuring fetal heart in 17.3% and 13.7% of cases respectively. Intraoperative complications were dominated by hemorrhage (15.5%). In our study, we noted an 11.1% of prevalence perinatal mortality. Cameroon is a low-income country with limited financial resources, especially in the Northern region. The health voucher program has improved financial access to caesarean sections for parturient in northern Cameroon, and consequently to emergency obstetric and neonatal care.展开更多
Caesarean section is dramatically increased throughout the world in recent years. Rupture of the uterus is a devastating complication in trial of labour following previous Caesarean section. Evidence suggests that the...Caesarean section is dramatically increased throughout the world in recent years. Rupture of the uterus is a devastating complication in trial of labour following previous Caesarean section. Evidence suggests that the size of the uterine scar and the residual myometrial thickness (RMT) are associated directly with the risk of uterine rupture and risk of dehiscence in subsequent deliveries. Impact of the prelabour and labour Cesarean section on the RMT has not been studied in detail. Objectives: To compare RMT, Caesarean scar defects and to evaluate the elasticity of the Caesarean scar between women who underwent prelabour and labour Caesarean sections. Methods: This was a Cross sectional analytical study. Women who underwent Caesarean section in their first pregnancy were recruited. Sample was stratified to prelabour and labour Caesarean section groups. Transvaginal ultrasound scan was performed six months following the Caesarean section. Dimensions of the uterus, uterine scar defect, RMT and elastosonography of the uterine scar were assessed. Results: A total of 240 postpartum women were analyzed. Uterine niche was detectable in 194 subjects. Prelabour CS group had demonstrated 91.7% (n = 110) scar defects (uterine niche) out of 120 cases and the rate among labour CS group was 70% (n = 84). There was a significant difference in the presence of uterine niche among 2 groups as Prelabour group was found to have more scar defects (p mm (SD 1.2) and 4.99 mm (SD 1.3) respectively and there was no significant difference (t = 0.38, p = 0.71). There was no significant difference between the dimensions of the uterine CS defects of the studied groups. Prelabour CS group had significantly higher Target strain [0.28 vs. 0.24 (t = 2.12, p = 0.04)] and significantly less strain ratio [1.45 vs. 1.55 (t -2.42, p = 0.04)] than labour CS group indicating a better scar in prelabour group. Conclusion: There was no significant difference in RMT and uterine scar defects between prelabour and labour Caesarean section groups. But prelabour Caesarean section scars were less stiff than labour Caesarean section scars. Further studies are warranted to elaborate on the association.展开更多
BACKGROUND Thrombotic pulmonary embolism(TPE)is one of the most critical diseases in obstetrics but is rarely reported in caesarean section(CS)because TPE patients in CS have a high risk of death and are difficult to ...BACKGROUND Thrombotic pulmonary embolism(TPE)is one of the most critical diseases in obstetrics but is rarely reported in caesarean section(CS)because TPE patients in CS have a high risk of death and are difficult to diagnose.This case report of TPE during CS was recorded by transthoracic echocardiography(TTE)and can provide a reference for the differential diagnosis of critical illnesses in CS.CASE SUMMARY A 37-year-old pregnant woman with rheumatic heart disease(RHD),gravida 5 and para 1(G5P1),presented for emergency CS at 33 wk and 3 d of gestation under general anesthesia because of acute heart failure,pulmonary hypertension and arrhythmia.After placental removal during CS,TTE revealed a nascent thrombus in the inferior vena cava(IVC)that elongated,detached and fragmented leading to acute thromboembolic events and acute TPE.This report presents the whole process and details of TPE during CS and successful rescue without any sequelae in the patient.This case gives us new ideas for the diagnosis of death or cardiovascular accidents during CS in pregnant women with heart disease and the detailed presentation of the rapid development of TPE may also elucidate new ideas for treatment.This case also highlighted the importance of prophylactic anticoagulation in the management of heart disease during pregnancy.CONCLUSION Pregnancy with heart failure could trigger inferior vena cava(IVC)-origin TPE during CS.Detection and timely treatment can avoid serious consequences.展开更多
Introduction: A caesarean section (CS) is one of the most frequently performed obstetric surgeries in the world and its use has increased dramatically in recent years. The number of caesarean section cases worldwide h...Introduction: A caesarean section (CS) is one of the most frequently performed obstetric surgeries in the world and its use has increased dramatically in recent years. The number of caesarean section cases worldwide has been increasing each year, and the World Health Organization (WHO) reported an excess of 10% - 15% of CS procedures for all births. However, some women experience surgical site infections (SSIs) after undergoing CS delivery. This study investigated the prescribing patterns of antibiotics in CS deliveries and the prevalence of SSIs at two tertiary hospitals in Lusaka, Zambia. Materials and Methods: A retrospective cross-sectional study was conducted from January 2020 to December 2020 at the Women and Newborn University Teaching Hospital (UTH) and the Levy Mwanawasa University Teaching Hospital, in Lusaka, Zambia. Results: Of a total of 838 women who delivered via CS, more than half were aged between 21 and 25 years (n = 461, 55.0%), 56.3% were from low-cost residential areas, and 57% had emergency CS delivery. The prevalence of SSIs was 6.0%, with the level of education (OR 0.377, 95% CI 0.150 - 0.946), type of caesarean section (OR 6.253, 95% CI 2.833 - 13.803), and oral antibiotics post-caesarean (OR 0.218, 95% CI 0.049 - 0.963). The duration of IV antibiotic treatment significantly predicted SSI (p Conclusion: This study found that the third-generation cephalosporin (cefotaxime) and triple combination therapy (benzylpenicillin, gentamicin, and metronidazole) were the most frequently prescribed antibiotics before and after CS. The level of education, type of CS, oral antibiotics post-CS, facility, and duration of administering IV antibiotics were all predictors of SSIs.展开更多
<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Globally, the rise in the rate of caesarean section is becomi...<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Globally, the rise in the rate of caesarean section is becoming a public health problem. This study examined the rate, indications and complications of caesarean section at the Federal Teaching Hospital Abakaliki (FETHA). </span><b><span style="font-family:Verdana;">Subjects and Methods:</span></b><span style="font-family:Verdana;"> This was a </span><span style="font-family:Verdana;">six-year</span><span style="font-family:Verdana;"> retrospective study covering January 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> 2012 to December 31</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> 2017. Patients who met the inclusion criteria were identified from the theatre records and their case notes retrieved from the health information unit of the hospital. Information extracted includes sociodemographic data, indications and types of caesarean section performed and the complications. Data was collected using a structured proforma and entered into a secured personal computer. Data analysis was performed </span><span style="font-family:Verdana;">by means of</span><span style="font-family:Verdana;"> Epi Info version 7. Results are presented in tables, means and simple percentages. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">During this period, a total of 11,215 deliveries were recorded at FETHA, of these, 3908 were delivered by CS giving a caesarean section rate of 34.8%. The mean age of the study subjects was 29.3 ± 5.03 years. Almost half (49.7%) of the patients were in the 20 - 29 age group. Multiparous women made up 36.0% while nulliparous women were 12.6%. T</span><span><span style="font-family:Verdana;">he most common indication for an emergency caesarean section was </span><span style="font-family:Verdana;">failure</span><span style="font-family:Verdana;"> to progress in labour with 20.0% contribution and the most common indication for elective caesarean section was </span><span style="font-family:Verdana;">previous</span><span style="font-family:Verdana;"> caesarean section with 13.5%. Majority of the babies were delivered at term (77.0%) with an average gestational age of 38 ± 2.6 weeks. Almost </span><span style="font-family:Verdana;">two-thirds</span><span style="font-family:Verdana;"> of the subjects (62.5%) had </span><span style="font-family:Verdana;">emergency</span><span style="font-family:Verdana;"> caesarean section. The average </span><span style="font-family:Verdana;">birthweight</span><span style="font-family:Verdana;"> was 3.03 ± 0.71 kg. Maternal anaemia was the most common complication </span><span style="font-family:Verdana;">recorded</span><span style="font-family:Verdana;"> 38.0%. There was direct maternal death in 2.0%</span></span><span style="font-family:Verdana;"> of the study population. Severe birth asphyxia was recorded in 12.3% of the babies while there was 3.2% perinatal death. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">There is a high rate of </span><span style="font-family:Verdana;">caesarean</span><span style="font-family:Verdana;"> section from this study. The World Health Organization has stated that there is no additional maternal or fetal benefit with </span><span style="font-family:Verdana;">caesarean</span><span style="font-family:Verdana;"> section rate of greater than 10% - 15%. Stakeholders and </span><span style="font-family:Verdana;">policy makers</span><span style="font-family:Verdana;"> need to do more to mitigate this rising trend.</span></span>展开更多
<strong>Background:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Quality assurance in labor and delivery is needed. The method...<strong>Background:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Quality assurance in labor and delivery is needed. The method must be simple and consistent, and be of universal value. The 10-Group Classification System is a simple method providing a common starting point for further detailed analysis within which all perinatal events and outcomes can be measured and compared. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> The purpose of this study was to analyze cesarean section (CS) rates using the classification system of Robson’s ten groups and to identify the main contributors to the overall CS rate in Burkina Faso’s regional and university hospitals. </span><b><span style="font-family:Verdana;">Materials and Method:</span></b><span style="font-family:Verdana;"> A cross-sectional study with retrospective collection was carried out. All women who gave birth between July 1, 2017 and June 30, 2018, in the Regional Hospital Centres (RHC) and University Hospital Centres (UHC) of Burkina Faso were classified according to the Robson ten-group method. The overall CS rates and in each Robson group were calculated, as well as the contribution of each group to the overall CS rate. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The CS rate was 26.5% (8543 out of 32,240 deliveries) during the study period. nulliparous women with single term pregnancy in cephalic presentation during spontaneous labour (group 1), multiparous women with single pregnancy in cephalic presentation, gestational age ≥37SA, spontaneous labour (group 3) and multiparous women with previous CS (group 5) were the main contributors (67.7%) to the overall CS rate. In addition, we observed a variation in CS rates between different hospitals, especially among women with full-term pregnancies in cephalic presentation without previous CS (groups 1 to 4), showing large differences in emergency obstetric and neonatal care across the country. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Women in groups 1, 3 and 5 were the most important contributors to the overall CS rate in Burkina Faso. It appears that efforts to reduce the overall rate of CS should focus on vaginal delivery on the scarred uterus, reduction of CS rates in nulliparous women with full-term pregnancy in cephalic presentation (groups 1) and proper monitoring of multiparous women with full-term pregnancy in spontaneous labour (group 3).</span></span>展开更多
Purpose: To compare the effect of chlorhexidine-alcohol and povidone iodine on surgical site infection (SSI) after caesarean section. Methodology: A randomized control trial of 374 patients (188 in the chlorhexidine-a...Purpose: To compare the effect of chlorhexidine-alcohol and povidone iodine on surgical site infection (SSI) after caesarean section. Methodology: A randomized control trial of 374 patients (188 in the chlorhexidine-alcohol group and 186 in the povidone iodine group) who had elective caesarean section with no overt risk for SSI was done. Patients were followed up until thirty days after delivery to assess for symptoms and signs of SSI. Results: Fifty-one (13.6%) of the study population developed SSI. Although the incidence of SSI was lower in the chlorhexidine-alcohol group than the povidone iodine group (12.2% vs. 15.1%;p = 0.26);the difference was not statistically significant. The incidence of adverse skin reaction in Chlorhexidine-alcohol vs. povidone iodine was also not statistically significant (4.0% vs. 5.4%;p = 0.40). Conclusion: The study demonstrates that there was no statistically significant difference in antiseptic property and side effect profile of chlorhexidine-alcohol and povidone-iodine when used as skin antisepsis in caesarean section.展开更多
Despite the complications related to the caesarean section, some couples choose it by desirability. This study aimed to understand the reasons for maternal requests for a planned caesarean section in Burkina Faso, in ...Despite the complications related to the caesarean section, some couples choose it by desirability. This study aimed to understand the reasons for maternal requests for a planned caesarean section in Burkina Faso, in the absence of obstetric indications. A qualitative descriptive study was conducted in March 2019, consisting of twelve semi-structured interviews with women requesting caesarean section at Tingandogo Teaching Hospital in Burkina Faso. The operative reports were also examined. Thematic analysis based on Braun and Clarke approach was performed with QDA Miner software. Twelve patients were involved in the study. The mean age was 33 years. The majority had a higher level of education. Half were employees. The mean stay duration was 72 hours, with an estimated cost of CFA 300.000 (457,347 EUR). The choice of a planned caesarean was motivated by fear of birth (tokophobia), the positive feeling associated to the surgical technology, the doctor-patient relationship and the confidence in the quality of healthcare services such as reception and hygiene. Maternal reasons for requesting a planned caesarean section in Burkina Faso are multifactorial. Information, education and communication and shared decision-making strategies concerning the different modes of delivery and complications at the end of pregnancy, may contribute to reducing this problem.展开更多
<strong>Aim</strong><strong>:</strong><span> Clinical audit is a tool to improve quality of care and to reduce maternal and perinatal morbidity and mortality. Auditing the CS according to...<strong>Aim</strong><strong>:</strong><span> Clinical audit is a tool to improve quality of care and to reduce maternal and perinatal morbidity and mortality. Auditing the CS according to a standard parameter will lead to strategies to avoid unnecessary intervention and to advice uniform practice. The aim was to evaluate the current practice and audit against international standards for various parameters relating to elective lower segment caesarean section and to assess compliance of physicians to audit standards.</span><span "=""> </span><b><span>Subject and methods: </span></b><span "=""><span>This is a cross-sectional study which was in a tertiary hospital in Kuwait from 1</span><sup><span>st</span></sup><span> October 2019 until 1</span><sup><span>st</span></sup><span> October 2020.</span><b> </b><span>The hospital medical, electronic records and case notes of three hundred and twenty-six </span><b><span>(326)</span></b><span> cases of elective caesarean sections were reviewed for study participants. Those women were booked under the care of internal and external physicians. Demographic data and primary outcomes were collected. </span><b><span>Results:</span></b><span> Outcome was measuring the compliance to the recognized Caesarean Section international standards: consent form, grade of LSCS, antacid and anti-emetics, type of anesthesia, uses of antibiotics, umbilical cord blood PH, and thromboprophylaxis.</span></span><span "=""> </span><span>The compliance for a signed consent form and cord blood PH was (100%), the use of preoperative antacid and antiemetic was (99.4%), combined regional anesthesia was given in (53.4%) of cases, preoperative antibiotics prophylaxis of second generation cephalosporin was</span><span "=""> </span><span>to (61.3%) of cases, post-operative thromboprophylaxis was given in (78.5%) of cases of which (33.6%) completed a 10 days duration.</span><span "=""> </span><span "=""><span>There was a statistically significant difference between internal and external physicians’ compliance regarding, type of anesthesia </span><b><span>2.3 (95%</span></b></span><b><span "=""> </span><span>CI, 1.3</span><span "=""> </span><span>-</span><span "=""> </span><span>4.1</span><span>, </span></b><span "=""><span>p = </span><b><span>0.004)</span></b><span>, type and timing of antibiotics </span><b><span>0.42 (95%</span></b></span><b><span "=""> </span><span>CI 0.22</span><span "=""> </span><span>-</span><span "=""> </span><span>0.79, </span></b><span "=""><span>p = </span><b><span>0.007) </span></b><span>and </span><b><span>0.33 (95%</span></b></span><b><span "=""> </span><span>CI 0.172</span><span "=""> </span><span>-</span><span "=""> </span><span>0.63,</span></b><span "=""><span> p = </span><b><span>0.0006) </span></b><span>and thromboprophylaxis </span><b><span>8.1 (95%</span></b></span><b><span "=""> </span><span>CI 2.80</span><span "=""> </span><span>-</span><span "=""> </span><span>23.23, </span></b><span "=""><span>p = </span><b><span>0.000)</span></b><span>.</span></span><span "=""> </span><b><span>Conclusion: </span></b><span "=""><span>The results are encouraging, but</span><b> </b><span>suboptimal compliance </span></span><span>i</span><span>s noticed mainly among external physicians.</span>展开更多
<strong>Introduction:</strong> <span><span><span style="font-family:""><span style="font-family:Verdana;">Caesarean section (CS) is a major reproductive hea...<strong>Introduction:</strong> <span><span><span style="font-family:""><span style="font-family:Verdana;">Caesarean section (CS) is a major reproductive health intervention to improve maternal and foetal outcomes if appropriately performed. </span><span style="font-family:Verdana;">This study aimed to assess the quality of Caesarean sections (CS) in a rural</span> <span><span style="font-family:Verdana;">setting in Cameroon. </span><b><span style="font-family:Verdana;">Materials and Methods: </span></b><span style="font-family:Verdana;">A prospective study con</span></span><span style="font-family:Verdana;">ducted in 3 hospitals from February 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> 2020 to April 30</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;"> 2020. One hundred and twenty women who had a CS were included. Data were grouped into 5 categories: </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">1</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">) Sociodemographic and obstetrical characteristics, </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">2</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">) Geographic and financial access, </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">3</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">) Diagnostic procedures, </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">4</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">) Operative parameters and </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">5</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">) Post-operative parameters. The Dujardin’s model and context-relevant</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> criteria served to construct the quality score. The scale was 0 </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> 20 and scores ≤ 15 were considered as unacceptable quality while those >15 were considered as acceptable quality CS. Logistic regressions permitted to measure associations. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> There were 538 deliveries and 120 (22.3%) CS. The mean (SD) gestational age was 38.7 (2.6) weeks with extremes of 31 and 43 weeks. Group 5 of the Robson’s classification was predominant (35.0%). Motorbikes were the mode of transport to the maternity for 72.5% (87/120) of women. No referral was made by ambulance. Only 44 (36.7%) women had paid the full cost of the CS prior to surgery. In addition, 26 (21.6%) women had a complete clinical examination on admission. The surgical team was not complete (<6 staffs) in 56 (43.3%) cases. Anaesthesia was done by nurses in all cases. CS was done by a general practitioner and by nurses in 86 (71.7%) and 14 (11.7%) cases respectively. Overall, mean (SD) quality score (QS) was 16.33 (1.60).</span><b> </b><span style="font-family:Verdana;">Sixty six of the 120 (55.3%) caesarean sections had unacceptable quality CS. Mean (SD) QS was significantly higher in faith-based hospitals than in public hospitals (18.00 (0.91) versus 15.59 (1.24);P</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">0.001).</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Immediate </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">postoperative clinical monitoring was effective only in 66 (55%) of cases. Apgar score was below 7 over 10 in 17 (14.2%) cases of which 6 freshes still births. No maternal death was recorded and maternal complications were recorded in 14 (11.7%) cases. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">The quality of CS is generally poor in rural settings in West-Cameroon. The quantity and quality of staffs required for Caesarean sections in the hospitals are sometimes insufficient. The poor quality of CS in this region could be addressed using the faith-based hospitals: St Vincent de Paul’s Hospital as a model.</span></span></span></span>展开更多
Background: Caesarean Section done in emergency basis can result some adverse outcome to both the fetus & mother & complications may arise. Objective: The purpose of the present study was to see the fetal &...Background: Caesarean Section done in emergency basis can result some adverse outcome to both the fetus & mother & complications may arise. Objective: The purpose of the present study was to see the fetal & maternal outcome or any complications among the pregnant woman who had undergone emergency caesarean section. Methodology: This descriptive type of cross sectional study was conducted in the Department of Gynaecology & Obstetrics at Dhaka Medical College Hospital during the period from July 2006 to December 2006. The patients underwent emergency caesarean section for any indication during the mentioned period of study was selected as study population. Among them, 100 cases were recruited in this study. Result: Among the cases, maternal morbidity was as high as 64% which were due to haemorrhage, post-operative infection, rise of blood pressure and other complications. Regarding fetal outcome, 92% babies were born with normal birth weight, 33% babies were developed complications which were mostly due to birth asphyxia and prematurity. Conclusion: In conclusion, emergency caesarean section has maternal morbidity as well as fetal and neonatal adverse outcome.展开更多
Obesity is a metabolic condition associated with </span><span style="font-family:Verdana;">a significant</span><span style="font-family:Verdana;"> morbidity and mortality ra...Obesity is a metabolic condition associated with </span><span style="font-family:Verdana;">a significant</span><span style="font-family:Verdana;"> morbidity and mortality rate. In the pregnant context, this risk is even higher because of the contingent of metabolic and </span><span style="font-family:Verdana;">haemodynamic</span><span style="font-family:Verdana;"> complications present in the ante-, intra- </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> post-partum periods. In these people, the recommended delivery method is </span><span style="font-family:Verdana;">caesarean</span><span style="font-family:Verdana;"> section, which is not easy to perform. </span><span style="font-family:Verdana;">Our aim is</span><span style="font-family:Verdana;"> to explain the particularities and advantages of epigastric incision in obese women during a caesarean section. The authors report the case of a patient who was admitted to the maternity ward of the Yaounde Central Hospital for management of a post-date</span></span><span style="font-family:Verdana;">,</span><span style="font-family:""><span style="font-family:Verdana;"> and in whom an elective </span><span style="font-family:Verdana;">caesarean</span><span style="font-family:Verdana;"> section was indicated with an epigastric approach. The vertical </span><span style="font-family:Verdana;">supra umbilical</span><span style="font-family:Verdana;"> incision should be recommended because it is subject to fewer complications</span></span><span style="font-family:Verdana;"> and</span><span style="font-family:""> <span style="font-family:Verdana;">reduces</span><span style="font-family:Verdana;"> the operating time and hospital stay.展开更多
Background: The rising caesarean section rate worldwide is an increasing source of concern to all. A significant contributor to this is a previous caesarean delivery. One strategy in the armamentarium of obstetricians...Background: The rising caesarean section rate worldwide is an increasing source of concern to all. A significant contributor to this is a previous caesarean delivery. One strategy in the armamentarium of obstetricians for reducing this is vaginal birth after one caesarean section (VBAC). The safety, outcome and complications of this procedure in our Center which is in a developing country had never been studied hence the need for this work. Aim: To find out the outcome and complications of vaginal births after one caesarean delivery in our Center. Method: A retrospective study involving a ten-year review of all cases of trials of labour after one caesarean delivery in our Center was done. Result: Of the 305 trials of labour after one caesarean delivery, 221 women had vaginal birth giving a vaginal birth after one caesarean section rate of 72.5%. Majority of the babies 303 (99.2%) were alive and had good Apgar scores while 2 (0.7%) died giving a perinatal mortality rate of 7 per 1000 babies. There were complications in 21 (6.7%) of the women with retained placenta, in 7 (2.3%) of the women as the commonest, followed by postpartum haemorrhage in 6 (1.96%). Five (1.62%) women had scar dehiscence while 3 (0.98%) had uterine rupture. Conclusion: Vaginal birth after one caesarean section is safe in well selected cases even in our resource poor settings. It offers our women a culturally-acceptable option of fulfilling long-held dreams of vaginal delivery even after one caesarean section and should be offered to our women whenever possible.展开更多
This study evaluated the efficacy and safety of "J"-shaped uterine incision for caesarean section for patients diagnosed with placenta previa.A total of 55 consecutive cases of placenta previa treated in Uni...This study evaluated the efficacy and safety of "J"-shaped uterine incision for caesarean section for patients diagnosed with placenta previa.A total of 55 consecutive cases of placenta previa treated in Union Hospital were retrospectively analyzed over a period of two years and 10 months.The subjects were divided into two groups with respect to the uterine incision.Twenty-four pregnant women with placenta previa who were indicated for caesarean section underwent the procedure using a new "J"-shaped uterine incision and 31 pregnant women with placenta previa received caesarean section that used the traditional transverse incision.The two groups were compared in terms of operation time,estimated blood loss,infant expulsion time,exhaust time and postoperative recovery.Meanwhile,comparison was also made in neonatal clinical data between the two groups.Compared with the "J"-shaped incision group,the traditional incision group had a lower Apgar scores(P<0.05).However,there existed no statistically significant differences in the overall time of operation and postoperative period of breaking wind(P>0.05).It is concluded that,with caesarean section for placenta previa patients,the "J"-shaped uterine incision significantly decreases intraoperative blood loss and facilitates the fetal delivery.展开更多
文摘BACKGROUND: Pain management following caesarean section still remains a challenge in our environment. Most potent analgesics are either not readily available or expensive. Diclofenac suppository is an NSAID that can be used for postoperative analgesia. It is available and affordable. OBJECTIVE: To compare the efficacy and safety of combined rectal diclofenac and intramuscular pentazocine with intramuscular pentazocine alone for post operative pain control following lower segment caesarean section. METHODOLOGY: A total of 120 women who met the selection criteria scheduled for caesarean section under spinal anaesthesia with bupivacaine were randomized into two equal groups to receive either 75 mg diclofenac suppository 12 hourly for 24 hours or one anusol suppository (the placebo) 12 hourly for 24 hours. Both groups received pentazocine as primary analgesia. RESULT: The primary outcome measure is the proportion of patients with severe pain at 24 hours using the visual analogue rating scale. Secondary outcome measures are the time from surgery to ambulation, Passage of flatus, maternal satisfaction and presence of complications. Statistical analysis was done using spss version 22 and graph pad statistical package. Student T-test was used for continuous variables whereas chi square was used for categorical variables P CONCLUSION: Adjuvant rectal diclofenac is superior to pentazocine alone in the management of pain after caesarean section. Less number of patients had moderate to severe pain at 24 hours post operation. Maternal satisfaction in relation to pain management is better with diclofenac suppository. The levels of complications were comparable in both groups.
文摘Background: The myometrium at the location of the CS (caesarean section) scars, also known as residual myometrium thickness (RMT), is larger after a double-layer uterine closure procedure than following a single-layer one. It may lessen the formation of a niche that is the myometrium’s disruption at the location of the scar of the uterus. Gynecological manifestations, obstetric problems in a future pregnancy and birth, and maybe subfertility are linked to thin RMT and a niche. Objective: To ascertain if double-layer unlocked closure of the uterus is better than single-layer one in terms of post-menstrual spotting and niche development following a first CS. Patients and Methods: In this randomized clinical study, 287 patients were evaluated for qualifying. Of all eligible individuals, 57 patients were excluded from the study based on the inclusion criteria. Results: The variation in ages, gestational age, body mass index (BMI), and cesarean section indications between the two assigned groups is statistically insignificant. However, postmenstrual spotting was statistically significantly more common in single-layer group compared to in double-group. The current study revealed ultrasound findings suggestive of niche formation was statistically significantly more common in single-layer group compared to in double-layer group. Conclusion: As evident from the current study, it demonstrates the advantages of double-layer unlocked closure of the uterus over single-layer one in terms of post-menstrual spotting and niche development following first-time cs. Thus, we deduced that fewer niches are formed, and fewer menstrual spotting occurs in the presence of double unlocked layers closure. To ascertain the impact of uterus closure method on post-operative niche development and the risk of obstetrics and gynaecological problems, further prospective trials with extended follow-up periods are required.
基金Curriculum Case Base Construction Project of the First Affiliated Hospital of Xinjiang Shihezi University,No.2021Y-AL15.
文摘BACKGROUND For the past few years,preventive interventional therapy has been widely used domestically and overseas,bringing great benefits to pregnant women at high-risk for complications,such as pernicious placenta previa(PPP)and placenta accreta.Nevertheless,there are still few reports on surgical complications related to interventional therapy,and its safety should be a concern.CASE SUMMARY We report a 36-year-old pregnant woman with PPP who underwent balloon implantation in the lower segment of the abdominal aorta before caesarean section.However,the balloon shifted during the operation,which damaged the arterial vessels after filling,resulting in severe postpartum haemorrhage in the patient.Fortunately,after emergency interventional stent implantation,the pa-tient was successfully relieved of the massive haemorrhage crisis.CONCLUSION It seems that massive postoperative bleeding has been largely avoided in preventive interventional therapy in high-risk pregnant women with placenta-related diseases,but surgical complications related to intervention therapy can also cause adverse consequences.It is equally important for clinical doctors to learn how to promptly identify and effectively treat these rare complications.
文摘Context: The caesarean section rate continues to increase in our different health structures specially for women who have not had a scar in the uterus. Objectives: The aim of this study was to analyze the key factors and main indications for primary caesarean sections and to find ways to reduce the increasing rates. Patients and Method: This is a longitudinal and retrospective study carried out from June 1, 2018 to July 31, 2022. The study included all patients who had a cesarean-section for the first time (primary caesarean). An anterior uterine scar was a non-inclusion criterion. Data were collected prospectively using Synfonievre and Agopra software via patients’ files and information collection sheet. Data were analyzed with SPSS 21 software, Mac version. Averages were calculated for quantitative data and percentages for qualitative data. The statistical tests used were the Pearson Chi<sup>2</sup> test. The observed differences were considered significant when the p-value was less than 0.05. Results: During the study period, we recorded 8832 deliveries and 3148 caesarean sections (35.6%). Primary CS concerned 70% of overall C-section rate. The main indications were FHR Fetal Heart Rate abnormalities (FHRA) (27%), followed by the other indications (including preterm delivery, umbilical cord dystocia, malpresentation of fetus, foetal abnormalities, elective CS, triple gestation, mother abnormalities);dystocia or prolonged labor (18.7%), breech presentation in a twin pregnancy with 11.3% and 9.6% respectively. We recorded more vaginal deliveries with labor induction: 81.4% against 75.2%. An obstetrical audit led to better labor management and a reduction in the cesarean section rate. Conclusion: We need to focus on diagnosis of fetal distress, management of breech presentation during of a twin birth and a singleton. Induction of labor can be an effective alternative in certain indications. An obstetrical audit is needed to reverse the caesarean section rate.
文摘Background: Blood loss during caesarean section (C/S) may lead to postpartum haemorrhage, and is one of the direct causes of maternal mortality and morbidity globally. Tranexamic acid is recommended in the treatment of postpartum haemorrhage (PPH) if oxytocin and other utertonics are ineffective in controlling PPH. In this centre it is not used prophylactically to reduce blood during caesarean section. Aim: To assess the effect of prophylactic intravenous tranexamic acid on blood loss during and after elective C/S at the University of Port Harcourt Teaching Hospital (UPTH). Methods: This was a prospective, single-blind, randomized, placebo-controlled interventional study conducted at the Obstetric theatre of UPTH from July 2020 to March 2021. Eligible women were randomized into two groups;seventy-two women received intravenous tranexamic acid while seventy-one women received a placebo. Socio-demographic data and the result of the study were collected through a proforma. Data collected was analyzed using Statistical Package for Social Sciences (SPSS) Version 22.0. The results were expressed in tables and charts as frequencies, percentages and mean. Chi-square test, Fisher’s exact, and T-test were used to determine the relationship between variables. P-value ≤ 0.05 was considered statistically significant. Results: The findings showed that tranexamic acid significantly reduced mean blood loss during and after C/S (p-value post-surgery was significantly lower in the tranexamic acid group (624.88 ± 200.76 ml) in comparison to the placebo group (864.24 ± 229.09 ml), p-value = 0.001. The mean post-C/S packed cell volume (PCV) was significantly higher among the tranexamic acid group (30.68% ± 2.80%) in comparison to the placebo group (28.07% ± 3.27%), t = 5.131, p-value = 0.0001. The maternal side effects were nausea and vomiting, 9 (12.5%) and 1 (1.4%) participants respectively. Conclusion: Tranexamic acid significantly reduced blood loss during and after elective C/S. Maternal side effects were less with tranexamic acid use.
文摘Background: The caesarean section rate is an important factor that characterizes the effectiveness of the obstetric service. The large variability of the initial state of women in labor and the variety of indications for surgery does not allow us to identify the main determinants. We attempted to determine and analyzed the first data on the structure and frequency of caesarean section in Armenia in the hospital of the Erebоuni multidisciplinary clinic before the introduction of the M. Robson scale. Methodology: We conducted a retrospective study of the history of childbirth in 38,111 patients registered at the Erebouni Medical Center for the period 2016-2021. The materials of the study were case histories, hospitalization materials and annual reports. Results: According to the obtained data, 80.5% of caesarean section operations were performed as planned. Only 14% of pregnant women were delivered by caesarean section according to absolute indications, the frequency of that in this maternity hospital increased from 36.77% to 44.95% over the analyzed period Conclusion: Thorough psychoprophylactic preparation of pregnant women for childbirth, including those with a scar on the uterus after a previous cesarean section, can ensure a steady desire of women in labor for vaginal delivery, full mobilization of their own capabilities, and more trusting cooperation with medical staff.
文摘Caesarean section (CS) is a surgical procedure performed to remove a fetus from the mother’s uterus through an incision on the abdominal wall, then on the uterine wall. The indications of CS vary not only between countries, but also from one hospital to another and from one team to another within the same hospital. Despite advances in asepsis and anesthesia/resuscitation technics, there are still complications of varying severity inherent to the gravid-puerperal state on one hand and the technics used on the other, irrespective of the operative indication. Thus, the present study was carried out with the objectives of determining the prevalence, identifying the indications, and evaluating the morbidity linked to caesarean sections in our environment. Cameroon has also set up a health voucher program in its northern region, aimed at reducing maternal and fetus morbidity and mortality. The program aims to improve financial access in antenatal care and deliveries, including caesarean sections, in this low-income region of the country. We conducted a descriptive cross-sectional study with retrospective data collection, from February 1, 2022, to May 31, 2022. We included all women who gave birth by caesarean section. In our study series, out of 905 parturient admissions into the Department of Obstetrics and Gynecology, 226 were caesarian cases. The overall frequency of CS during our study period was 25%. Fetal indications were dominated by cephalopelvic disproportion and non-reassuring fetal heart in 17.3% and 13.7% of cases respectively. Intraoperative complications were dominated by hemorrhage (15.5%). In our study, we noted an 11.1% of prevalence perinatal mortality. Cameroon is a low-income country with limited financial resources, especially in the Northern region. The health voucher program has improved financial access to caesarean sections for parturient in northern Cameroon, and consequently to emergency obstetric and neonatal care.
文摘Caesarean section is dramatically increased throughout the world in recent years. Rupture of the uterus is a devastating complication in trial of labour following previous Caesarean section. Evidence suggests that the size of the uterine scar and the residual myometrial thickness (RMT) are associated directly with the risk of uterine rupture and risk of dehiscence in subsequent deliveries. Impact of the prelabour and labour Cesarean section on the RMT has not been studied in detail. Objectives: To compare RMT, Caesarean scar defects and to evaluate the elasticity of the Caesarean scar between women who underwent prelabour and labour Caesarean sections. Methods: This was a Cross sectional analytical study. Women who underwent Caesarean section in their first pregnancy were recruited. Sample was stratified to prelabour and labour Caesarean section groups. Transvaginal ultrasound scan was performed six months following the Caesarean section. Dimensions of the uterus, uterine scar defect, RMT and elastosonography of the uterine scar were assessed. Results: A total of 240 postpartum women were analyzed. Uterine niche was detectable in 194 subjects. Prelabour CS group had demonstrated 91.7% (n = 110) scar defects (uterine niche) out of 120 cases and the rate among labour CS group was 70% (n = 84). There was a significant difference in the presence of uterine niche among 2 groups as Prelabour group was found to have more scar defects (p mm (SD 1.2) and 4.99 mm (SD 1.3) respectively and there was no significant difference (t = 0.38, p = 0.71). There was no significant difference between the dimensions of the uterine CS defects of the studied groups. Prelabour CS group had significantly higher Target strain [0.28 vs. 0.24 (t = 2.12, p = 0.04)] and significantly less strain ratio [1.45 vs. 1.55 (t -2.42, p = 0.04)] than labour CS group indicating a better scar in prelabour group. Conclusion: There was no significant difference in RMT and uterine scar defects between prelabour and labour Caesarean section groups. But prelabour Caesarean section scars were less stiff than labour Caesarean section scars. Further studies are warranted to elaborate on the association.
基金Supported by the National Natural Science Foundation of China,No.81870320the Health Science and Technology Project of Guangzhou,No.20191A011086.
文摘BACKGROUND Thrombotic pulmonary embolism(TPE)is one of the most critical diseases in obstetrics but is rarely reported in caesarean section(CS)because TPE patients in CS have a high risk of death and are difficult to diagnose.This case report of TPE during CS was recorded by transthoracic echocardiography(TTE)and can provide a reference for the differential diagnosis of critical illnesses in CS.CASE SUMMARY A 37-year-old pregnant woman with rheumatic heart disease(RHD),gravida 5 and para 1(G5P1),presented for emergency CS at 33 wk and 3 d of gestation under general anesthesia because of acute heart failure,pulmonary hypertension and arrhythmia.After placental removal during CS,TTE revealed a nascent thrombus in the inferior vena cava(IVC)that elongated,detached and fragmented leading to acute thromboembolic events and acute TPE.This report presents the whole process and details of TPE during CS and successful rescue without any sequelae in the patient.This case gives us new ideas for the diagnosis of death or cardiovascular accidents during CS in pregnant women with heart disease and the detailed presentation of the rapid development of TPE may also elucidate new ideas for treatment.This case also highlighted the importance of prophylactic anticoagulation in the management of heart disease during pregnancy.CONCLUSION Pregnancy with heart failure could trigger inferior vena cava(IVC)-origin TPE during CS.Detection and timely treatment can avoid serious consequences.
文摘Introduction: A caesarean section (CS) is one of the most frequently performed obstetric surgeries in the world and its use has increased dramatically in recent years. The number of caesarean section cases worldwide has been increasing each year, and the World Health Organization (WHO) reported an excess of 10% - 15% of CS procedures for all births. However, some women experience surgical site infections (SSIs) after undergoing CS delivery. This study investigated the prescribing patterns of antibiotics in CS deliveries and the prevalence of SSIs at two tertiary hospitals in Lusaka, Zambia. Materials and Methods: A retrospective cross-sectional study was conducted from January 2020 to December 2020 at the Women and Newborn University Teaching Hospital (UTH) and the Levy Mwanawasa University Teaching Hospital, in Lusaka, Zambia. Results: Of a total of 838 women who delivered via CS, more than half were aged between 21 and 25 years (n = 461, 55.0%), 56.3% were from low-cost residential areas, and 57% had emergency CS delivery. The prevalence of SSIs was 6.0%, with the level of education (OR 0.377, 95% CI 0.150 - 0.946), type of caesarean section (OR 6.253, 95% CI 2.833 - 13.803), and oral antibiotics post-caesarean (OR 0.218, 95% CI 0.049 - 0.963). The duration of IV antibiotic treatment significantly predicted SSI (p Conclusion: This study found that the third-generation cephalosporin (cefotaxime) and triple combination therapy (benzylpenicillin, gentamicin, and metronidazole) were the most frequently prescribed antibiotics before and after CS. The level of education, type of CS, oral antibiotics post-CS, facility, and duration of administering IV antibiotics were all predictors of SSIs.
文摘<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Globally, the rise in the rate of caesarean section is becoming a public health problem. This study examined the rate, indications and complications of caesarean section at the Federal Teaching Hospital Abakaliki (FETHA). </span><b><span style="font-family:Verdana;">Subjects and Methods:</span></b><span style="font-family:Verdana;"> This was a </span><span style="font-family:Verdana;">six-year</span><span style="font-family:Verdana;"> retrospective study covering January 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> 2012 to December 31</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> 2017. Patients who met the inclusion criteria were identified from the theatre records and their case notes retrieved from the health information unit of the hospital. Information extracted includes sociodemographic data, indications and types of caesarean section performed and the complications. Data was collected using a structured proforma and entered into a secured personal computer. Data analysis was performed </span><span style="font-family:Verdana;">by means of</span><span style="font-family:Verdana;"> Epi Info version 7. Results are presented in tables, means and simple percentages. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">During this period, a total of 11,215 deliveries were recorded at FETHA, of these, 3908 were delivered by CS giving a caesarean section rate of 34.8%. The mean age of the study subjects was 29.3 ± 5.03 years. Almost half (49.7%) of the patients were in the 20 - 29 age group. Multiparous women made up 36.0% while nulliparous women were 12.6%. T</span><span><span style="font-family:Verdana;">he most common indication for an emergency caesarean section was </span><span style="font-family:Verdana;">failure</span><span style="font-family:Verdana;"> to progress in labour with 20.0% contribution and the most common indication for elective caesarean section was </span><span style="font-family:Verdana;">previous</span><span style="font-family:Verdana;"> caesarean section with 13.5%. Majority of the babies were delivered at term (77.0%) with an average gestational age of 38 ± 2.6 weeks. Almost </span><span style="font-family:Verdana;">two-thirds</span><span style="font-family:Verdana;"> of the subjects (62.5%) had </span><span style="font-family:Verdana;">emergency</span><span style="font-family:Verdana;"> caesarean section. The average </span><span style="font-family:Verdana;">birthweight</span><span style="font-family:Verdana;"> was 3.03 ± 0.71 kg. Maternal anaemia was the most common complication </span><span style="font-family:Verdana;">recorded</span><span style="font-family:Verdana;"> 38.0%. There was direct maternal death in 2.0%</span></span><span style="font-family:Verdana;"> of the study population. Severe birth asphyxia was recorded in 12.3% of the babies while there was 3.2% perinatal death. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">There is a high rate of </span><span style="font-family:Verdana;">caesarean</span><span style="font-family:Verdana;"> section from this study. The World Health Organization has stated that there is no additional maternal or fetal benefit with </span><span style="font-family:Verdana;">caesarean</span><span style="font-family:Verdana;"> section rate of greater than 10% - 15%. Stakeholders and </span><span style="font-family:Verdana;">policy makers</span><span style="font-family:Verdana;"> need to do more to mitigate this rising trend.</span></span>
文摘<strong>Background:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Quality assurance in labor and delivery is needed. The method must be simple and consistent, and be of universal value. The 10-Group Classification System is a simple method providing a common starting point for further detailed analysis within which all perinatal events and outcomes can be measured and compared. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> The purpose of this study was to analyze cesarean section (CS) rates using the classification system of Robson’s ten groups and to identify the main contributors to the overall CS rate in Burkina Faso’s regional and university hospitals. </span><b><span style="font-family:Verdana;">Materials and Method:</span></b><span style="font-family:Verdana;"> A cross-sectional study with retrospective collection was carried out. All women who gave birth between July 1, 2017 and June 30, 2018, in the Regional Hospital Centres (RHC) and University Hospital Centres (UHC) of Burkina Faso were classified according to the Robson ten-group method. The overall CS rates and in each Robson group were calculated, as well as the contribution of each group to the overall CS rate. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The CS rate was 26.5% (8543 out of 32,240 deliveries) during the study period. nulliparous women with single term pregnancy in cephalic presentation during spontaneous labour (group 1), multiparous women with single pregnancy in cephalic presentation, gestational age ≥37SA, spontaneous labour (group 3) and multiparous women with previous CS (group 5) were the main contributors (67.7%) to the overall CS rate. In addition, we observed a variation in CS rates between different hospitals, especially among women with full-term pregnancies in cephalic presentation without previous CS (groups 1 to 4), showing large differences in emergency obstetric and neonatal care across the country. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Women in groups 1, 3 and 5 were the most important contributors to the overall CS rate in Burkina Faso. It appears that efforts to reduce the overall rate of CS should focus on vaginal delivery on the scarred uterus, reduction of CS rates in nulliparous women with full-term pregnancy in cephalic presentation (groups 1) and proper monitoring of multiparous women with full-term pregnancy in spontaneous labour (group 3).</span></span>
文摘Purpose: To compare the effect of chlorhexidine-alcohol and povidone iodine on surgical site infection (SSI) after caesarean section. Methodology: A randomized control trial of 374 patients (188 in the chlorhexidine-alcohol group and 186 in the povidone iodine group) who had elective caesarean section with no overt risk for SSI was done. Patients were followed up until thirty days after delivery to assess for symptoms and signs of SSI. Results: Fifty-one (13.6%) of the study population developed SSI. Although the incidence of SSI was lower in the chlorhexidine-alcohol group than the povidone iodine group (12.2% vs. 15.1%;p = 0.26);the difference was not statistically significant. The incidence of adverse skin reaction in Chlorhexidine-alcohol vs. povidone iodine was also not statistically significant (4.0% vs. 5.4%;p = 0.40). Conclusion: The study demonstrates that there was no statistically significant difference in antiseptic property and side effect profile of chlorhexidine-alcohol and povidone-iodine when used as skin antisepsis in caesarean section.
文摘Despite the complications related to the caesarean section, some couples choose it by desirability. This study aimed to understand the reasons for maternal requests for a planned caesarean section in Burkina Faso, in the absence of obstetric indications. A qualitative descriptive study was conducted in March 2019, consisting of twelve semi-structured interviews with women requesting caesarean section at Tingandogo Teaching Hospital in Burkina Faso. The operative reports were also examined. Thematic analysis based on Braun and Clarke approach was performed with QDA Miner software. Twelve patients were involved in the study. The mean age was 33 years. The majority had a higher level of education. Half were employees. The mean stay duration was 72 hours, with an estimated cost of CFA 300.000 (457,347 EUR). The choice of a planned caesarean was motivated by fear of birth (tokophobia), the positive feeling associated to the surgical technology, the doctor-patient relationship and the confidence in the quality of healthcare services such as reception and hygiene. Maternal reasons for requesting a planned caesarean section in Burkina Faso are multifactorial. Information, education and communication and shared decision-making strategies concerning the different modes of delivery and complications at the end of pregnancy, may contribute to reducing this problem.
文摘<strong>Aim</strong><strong>:</strong><span> Clinical audit is a tool to improve quality of care and to reduce maternal and perinatal morbidity and mortality. Auditing the CS according to a standard parameter will lead to strategies to avoid unnecessary intervention and to advice uniform practice. The aim was to evaluate the current practice and audit against international standards for various parameters relating to elective lower segment caesarean section and to assess compliance of physicians to audit standards.</span><span "=""> </span><b><span>Subject and methods: </span></b><span "=""><span>This is a cross-sectional study which was in a tertiary hospital in Kuwait from 1</span><sup><span>st</span></sup><span> October 2019 until 1</span><sup><span>st</span></sup><span> October 2020.</span><b> </b><span>The hospital medical, electronic records and case notes of three hundred and twenty-six </span><b><span>(326)</span></b><span> cases of elective caesarean sections were reviewed for study participants. Those women were booked under the care of internal and external physicians. Demographic data and primary outcomes were collected. </span><b><span>Results:</span></b><span> Outcome was measuring the compliance to the recognized Caesarean Section international standards: consent form, grade of LSCS, antacid and anti-emetics, type of anesthesia, uses of antibiotics, umbilical cord blood PH, and thromboprophylaxis.</span></span><span "=""> </span><span>The compliance for a signed consent form and cord blood PH was (100%), the use of preoperative antacid and antiemetic was (99.4%), combined regional anesthesia was given in (53.4%) of cases, preoperative antibiotics prophylaxis of second generation cephalosporin was</span><span "=""> </span><span>to (61.3%) of cases, post-operative thromboprophylaxis was given in (78.5%) of cases of which (33.6%) completed a 10 days duration.</span><span "=""> </span><span "=""><span>There was a statistically significant difference between internal and external physicians’ compliance regarding, type of anesthesia </span><b><span>2.3 (95%</span></b></span><b><span "=""> </span><span>CI, 1.3</span><span "=""> </span><span>-</span><span "=""> </span><span>4.1</span><span>, </span></b><span "=""><span>p = </span><b><span>0.004)</span></b><span>, type and timing of antibiotics </span><b><span>0.42 (95%</span></b></span><b><span "=""> </span><span>CI 0.22</span><span "=""> </span><span>-</span><span "=""> </span><span>0.79, </span></b><span "=""><span>p = </span><b><span>0.007) </span></b><span>and </span><b><span>0.33 (95%</span></b></span><b><span "=""> </span><span>CI 0.172</span><span "=""> </span><span>-</span><span "=""> </span><span>0.63,</span></b><span "=""><span> p = </span><b><span>0.0006) </span></b><span>and thromboprophylaxis </span><b><span>8.1 (95%</span></b></span><b><span "=""> </span><span>CI 2.80</span><span "=""> </span><span>-</span><span "=""> </span><span>23.23, </span></b><span "=""><span>p = </span><b><span>0.000)</span></b><span>.</span></span><span "=""> </span><b><span>Conclusion: </span></b><span "=""><span>The results are encouraging, but</span><b> </b><span>suboptimal compliance </span></span><span>i</span><span>s noticed mainly among external physicians.</span>
文摘<strong>Introduction:</strong> <span><span><span style="font-family:""><span style="font-family:Verdana;">Caesarean section (CS) is a major reproductive health intervention to improve maternal and foetal outcomes if appropriately performed. </span><span style="font-family:Verdana;">This study aimed to assess the quality of Caesarean sections (CS) in a rural</span> <span><span style="font-family:Verdana;">setting in Cameroon. </span><b><span style="font-family:Verdana;">Materials and Methods: </span></b><span style="font-family:Verdana;">A prospective study con</span></span><span style="font-family:Verdana;">ducted in 3 hospitals from February 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> 2020 to April 30</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;"> 2020. One hundred and twenty women who had a CS were included. Data were grouped into 5 categories: </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">1</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">) Sociodemographic and obstetrical characteristics, </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">2</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">) Geographic and financial access, </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">3</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">) Diagnostic procedures, </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">4</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">) Operative parameters and </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">5</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">) Post-operative parameters. The Dujardin’s model and context-relevant</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> criteria served to construct the quality score. The scale was 0 </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> 20 and scores ≤ 15 were considered as unacceptable quality while those >15 were considered as acceptable quality CS. Logistic regressions permitted to measure associations. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> There were 538 deliveries and 120 (22.3%) CS. The mean (SD) gestational age was 38.7 (2.6) weeks with extremes of 31 and 43 weeks. Group 5 of the Robson’s classification was predominant (35.0%). Motorbikes were the mode of transport to the maternity for 72.5% (87/120) of women. No referral was made by ambulance. Only 44 (36.7%) women had paid the full cost of the CS prior to surgery. In addition, 26 (21.6%) women had a complete clinical examination on admission. The surgical team was not complete (<6 staffs) in 56 (43.3%) cases. Anaesthesia was done by nurses in all cases. CS was done by a general practitioner and by nurses in 86 (71.7%) and 14 (11.7%) cases respectively. Overall, mean (SD) quality score (QS) was 16.33 (1.60).</span><b> </b><span style="font-family:Verdana;">Sixty six of the 120 (55.3%) caesarean sections had unacceptable quality CS. Mean (SD) QS was significantly higher in faith-based hospitals than in public hospitals (18.00 (0.91) versus 15.59 (1.24);P</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">0.001).</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Immediate </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">postoperative clinical monitoring was effective only in 66 (55%) of cases. Apgar score was below 7 over 10 in 17 (14.2%) cases of which 6 freshes still births. No maternal death was recorded and maternal complications were recorded in 14 (11.7%) cases. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">The quality of CS is generally poor in rural settings in West-Cameroon. The quantity and quality of staffs required for Caesarean sections in the hospitals are sometimes insufficient. The poor quality of CS in this region could be addressed using the faith-based hospitals: St Vincent de Paul’s Hospital as a model.</span></span></span></span>
文摘Background: Caesarean Section done in emergency basis can result some adverse outcome to both the fetus & mother & complications may arise. Objective: The purpose of the present study was to see the fetal & maternal outcome or any complications among the pregnant woman who had undergone emergency caesarean section. Methodology: This descriptive type of cross sectional study was conducted in the Department of Gynaecology & Obstetrics at Dhaka Medical College Hospital during the period from July 2006 to December 2006. The patients underwent emergency caesarean section for any indication during the mentioned period of study was selected as study population. Among them, 100 cases were recruited in this study. Result: Among the cases, maternal morbidity was as high as 64% which were due to haemorrhage, post-operative infection, rise of blood pressure and other complications. Regarding fetal outcome, 92% babies were born with normal birth weight, 33% babies were developed complications which were mostly due to birth asphyxia and prematurity. Conclusion: In conclusion, emergency caesarean section has maternal morbidity as well as fetal and neonatal adverse outcome.
文摘Obesity is a metabolic condition associated with </span><span style="font-family:Verdana;">a significant</span><span style="font-family:Verdana;"> morbidity and mortality rate. In the pregnant context, this risk is even higher because of the contingent of metabolic and </span><span style="font-family:Verdana;">haemodynamic</span><span style="font-family:Verdana;"> complications present in the ante-, intra- </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> post-partum periods. In these people, the recommended delivery method is </span><span style="font-family:Verdana;">caesarean</span><span style="font-family:Verdana;"> section, which is not easy to perform. </span><span style="font-family:Verdana;">Our aim is</span><span style="font-family:Verdana;"> to explain the particularities and advantages of epigastric incision in obese women during a caesarean section. The authors report the case of a patient who was admitted to the maternity ward of the Yaounde Central Hospital for management of a post-date</span></span><span style="font-family:Verdana;">,</span><span style="font-family:""><span style="font-family:Verdana;"> and in whom an elective </span><span style="font-family:Verdana;">caesarean</span><span style="font-family:Verdana;"> section was indicated with an epigastric approach. The vertical </span><span style="font-family:Verdana;">supra umbilical</span><span style="font-family:Verdana;"> incision should be recommended because it is subject to fewer complications</span></span><span style="font-family:Verdana;"> and</span><span style="font-family:""> <span style="font-family:Verdana;">reduces</span><span style="font-family:Verdana;"> the operating time and hospital stay.
文摘Background: The rising caesarean section rate worldwide is an increasing source of concern to all. A significant contributor to this is a previous caesarean delivery. One strategy in the armamentarium of obstetricians for reducing this is vaginal birth after one caesarean section (VBAC). The safety, outcome and complications of this procedure in our Center which is in a developing country had never been studied hence the need for this work. Aim: To find out the outcome and complications of vaginal births after one caesarean delivery in our Center. Method: A retrospective study involving a ten-year review of all cases of trials of labour after one caesarean delivery in our Center was done. Result: Of the 305 trials of labour after one caesarean delivery, 221 women had vaginal birth giving a vaginal birth after one caesarean section rate of 72.5%. Majority of the babies 303 (99.2%) were alive and had good Apgar scores while 2 (0.7%) died giving a perinatal mortality rate of 7 per 1000 babies. There were complications in 21 (6.7%) of the women with retained placenta, in 7 (2.3%) of the women as the commonest, followed by postpartum haemorrhage in 6 (1.96%). Five (1.62%) women had scar dehiscence while 3 (0.98%) had uterine rupture. Conclusion: Vaginal birth after one caesarean section is safe in well selected cases even in our resource poor settings. It offers our women a culturally-acceptable option of fulfilling long-held dreams of vaginal delivery even after one caesarean section and should be offered to our women whenever possible.
基金supported by a grant from the National Natural Sciences Foundation of China (No. 30872776)
文摘This study evaluated the efficacy and safety of "J"-shaped uterine incision for caesarean section for patients diagnosed with placenta previa.A total of 55 consecutive cases of placenta previa treated in Union Hospital were retrospectively analyzed over a period of two years and 10 months.The subjects were divided into two groups with respect to the uterine incision.Twenty-four pregnant women with placenta previa who were indicated for caesarean section underwent the procedure using a new "J"-shaped uterine incision and 31 pregnant women with placenta previa received caesarean section that used the traditional transverse incision.The two groups were compared in terms of operation time,estimated blood loss,infant expulsion time,exhaust time and postoperative recovery.Meanwhile,comparison was also made in neonatal clinical data between the two groups.Compared with the "J"-shaped incision group,the traditional incision group had a lower Apgar scores(P<0.05).However,there existed no statistically significant differences in the overall time of operation and postoperative period of breaking wind(P>0.05).It is concluded that,with caesarean section for placenta previa patients,the "J"-shaped uterine incision significantly decreases intraoperative blood loss and facilitates the fetal delivery.
