Objective:To analyze the effect of midwife psychological nursing intervention in the clinical care of elderly women in labor.Methods:According to the order of admission,74 elderly women were divided into the control g...Objective:To analyze the effect of midwife psychological nursing intervention in the clinical care of elderly women in labor.Methods:According to the order of admission,74 elderly women were divided into the control group and the observation group.In addition to the routine perinatal nursing interventions,the observation group strengthened the implementation of midwives’psychological nursing interventions.The duration of labor,mode of delivery,psychological state,and stress response indexes of the two groups were analyzed and compared.Results:The observation group had a shorter duration of all labor stages and total duration of labor than the control group,a lower cesarean section rate than the control group,and a higher degree of improvement in anxiety,depression,and stress response indexes in the 3-day postpartum period as compared to the control group(P<0.05).Conclusion:The implementation of midwife psychological care intervention in perinatal care of elderly women can further shorten the duration of labor,reduce the cesarean section rate,and improve the psychological state and stress indicators,which is worth promoting.展开更多
Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most o...Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most of obstetricians to increase the num ber of cesarean sections following a previous cesarean section. Guidelines for Vaginal birth after cesarean (VBAC) indicate that TOLAC offers women with no contraindications and one previous transverse low-segment cesarean. The objective of the current study was to study the outcome of trial of labour after caesarean section (TOLAC), the indications for emergency repeat cesarean section and to determine the maternal and fetal prognosis in vaginal birth after caesarian section (VBAC) at Tshikaji Mission Hospital. Patients, Material and Methods: This is a retrospective study of the records of 126 women were selected to undergo the TOLAC in the department of gynecology and obstetrics at the Tshikaji Mission Hospital over the period from January 1<sup>st</sup> to December 31<sup>st</sup>, 2021. The data on demography, antenatal care, labour and delivery and outcomes were collected from the maternity unit of this hospital. The data were analyzed using SPSS version 2.0. Results: The TOLAC in 126 studied women. The course of work allowed vaginal delivery 107 parturient women, a success rate of successful VBAC of 85% after the TOLAC. The repeat emergency cesarean section was necessary for delivery in 15% of cases for failed TOLAC. There was no maternal mortality, but we recorded one fetal death or 0.8% of perinatal mortality, 2 cases of cicatricial dehiscence, the incidence of 1.6%. Maternal morbidity after delivery on cicatricial uterus was dominated by postpartum hemorrhages, with 19 cases or 15.1% of cases. Cervical dilatation of more than 3 cm at the time of admission, the parity more than 3 and were the significant factors in favor of a successful VBAC. Birth weight of more than 3500 g, fetal distress and malpresentation were associated with a lower success rate of VBAC. The TOLAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. Conclusion: Pregnancy on a cicatricial uterus represents a high-risk pregnancy. Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. There is a significantly high vaginal birth after caesarian section (VBAC) success rate among selected women undergoing trial of scar in Tshikaji Hospital. TOLAC remains the option for childbirth in low resource settings as Kasai region in DRC. Adequate patient education and counselling in addition to appropriate patient selection for TOLAC remain the cornerstone to achieving high VBAC success rate.展开更多
Background: Cesarean delivery has become the most common major surgical procedure in many parts of the world. Induction of labor in women with prior cesarean delivery is an alternative to mitigate the rising cesarean ...Background: Cesarean delivery has become the most common major surgical procedure in many parts of the world. Induction of labor in women with prior cesarean delivery is an alternative to mitigate the rising cesarean rates. Objectives: To compare the VBAC success rate between two vaginal forms of dinoprostone for labor induction in women with prior cesarean section. Material and Methods: A pilot study was conducted at a large Governmental Hospital, Dhahran, Saudi Arabia, including 200 women with prior cesarean section and planned for labor induction. Participants were randomly allocated into two groups. Group A (n = 100) received dinoprostone 1.5 mg vaginal tablet. Group B (n = 100) received 10 mg dinoprostone sustained release vaginal pessary. Primary outcome was vaginal delivery rate. Secondary outcomes included maternal and neonatal outcomes. Results: The dinoprostone vaginal tablet and dinoprostone vaginal pessary had a comparable vaginal delivery rate (67% and 64%, respectively;p = 0.78). The median patient satisfaction with the birth process was superior in the dinoprostone vaginal pessary group (p = 0.04). Maternal and neonatal outcomes were similar in both groups. Conclusion: Both forms of dinoprostone were effective methods for labor induction in women with prior cesarean section. However, the patient satisfaction with the birth process was in favor of the dinoprostone sustained release vaginal pessary.展开更多
Objective: To review the outcome of prostaglandin induction of labor in term pregnant women with previous one ce-sarean section compared to those without previous Cesarean section. Design: 18 years retrospective revie...Objective: To review the outcome of prostaglandin induction of labor in term pregnant women with previous one ce-sarean section compared to those without previous Cesarean section. Design: 18 years retrospective review of hospital records and case note review of index cases. Setting: University hospital. Population: Three hundred and twenty two women who had their labor induced with prostaglandin E2. One hundred and sixty one women had one previous Ce-sarean section. Methods: This study was conducted at King Fahad University Hospital, University of Dammam. It is a tertiary referral center with approximately 2300 births per year. We searched the hospital's records of deliveries from January 1992 to December 2009 and reviewed all indications and outcomes of prostaglandin induction of labor in women with one previous Cesarean section. The control group was composed of women who had their labor induced with prostaglandin but without previous Cesarean section. Main outcome measures: Labor outcome and uterine rup-ture Results: Three hundred and twenty two women were included. All received prostaglandin E2 for induction of labor. One hundred and sixty one women had one previous Cesarean section (study group) and the rest had no previous Ce-sarean section (control group). There was no difference in the rate of vaginal delivery between study and control group, 68.3% and 79.5% (p value 0.3), respectively. The rate of uterine rupture was 30 times higher in study group (2.5% Vs 0.033%). Conclusion: In women with one previous Cesarean section, induction of labor with prostaglandin leads to comparable rate of vaginal delivery similar to those without prior Cesarean section but with relatively high risk of uter-ine rupture.展开更多
Objective: To evaluate the effect of chewing sugar-free gum on gastrointestinal function recovery after cesarean section. Methods: Randomized controlled trials comparing the use of chewing gum in postoperative recover...Objective: To evaluate the effect of chewing sugar-free gum on gastrointestinal function recovery after cesarean section. Methods: Randomized controlled trials comparing the use of chewing gum in postoperative recovery with a control group were retrieved from the databases including Pubmed, Cochrane Library, Science Direct, Web of Science, CBM, CNKI, Wanfang and VIP, et al. After screening literatures, evaluating the quality of studies, extracting data, the RevMan5.3 software was used for data analysis. Results: A total of 13 RCTs including 2233 patients were analyzed in the study. The results showed that chewing gum after cesarean delivery can effectively shorten the recovery time of bowel sounds, passage of flatus and first defecation (all P Conclusion: Chewing sugar-free gum after cesarean section can promote the early recovery of gastrointestinal function, but the side effects of chewing gum are still unclear, which needs more clinical, large sample and high-quality studies to further verify.展开更多
Background: Cesarean section (CS) has increased steadily over the last decade, with an estimated one-third of women delivering by cesarean section worldwide. Objective: Our study aimed to investigate the demographic a...Background: Cesarean section (CS) has increased steadily over the last decade, with an estimated one-third of women delivering by cesarean section worldwide. Objective: Our study aimed to investigate the demographic and associated factors influencing vaginal birth after one cesarean (VBAC-1) success focusing on variables like pre-pregnancy BMI, diabetes, hypertension, education, and smoking. Study Design and Methods: In this retrospective study, we analyzed 285 cases (81 unsuccessful VBAC-1, 204 successful VBAC-1) from San Juan City Hospital (Puerto Rico) between January 1, 2019, and December 31, 2020. We used odds ratios and model selection comparison to assess the impact of variables on successful VBAC-1, using a significance threshold of 95% CI. Model selection assessed binomial model combinations using a generalized linear approach to identify key risk factors. Results: Unsuccessful VBAC-1 (a repeat cesarean), was associated with diabetes (OR: 0.376, p = 0.086), hypertension (OR: 0.23, p = 0.006), and university-educated women (OR: 1.372, p = 0.711). High school-educated women had an OR of 3.966 (p = 0.105), while overweight women were 0.481 times more likely to have unsuccessful VBAC-1 (p = 0.041). Significant associations were not found with obesity (OR: 0.574, p = 0.122), underweight/normal (OR: 1.01, p = 0.810), or smoking (OR: 1.227, p = 0.990). Conclusion: Results revealed women with higher education levels, hypertension, or diabetes are less likely to have a successful VBAC-1. Understanding the complex interactions affecting these outcomes is aimed at establishing guidelines for healthcare professionals to conduct systematic risk/benefit assessments. This study lays a foundation for evidence-based practices and policies, offering initial insights into VBAC-1 success factors in Puerto Rico.展开更多
BACKGROUND Vaginal delivery is the ideal mode of delivery for the termination of a pregnancy.However,the cesarean section rate in China is much higher than the published by the World Health Organization in the Lancet ...BACKGROUND Vaginal delivery is the ideal mode of delivery for the termination of a pregnancy.However,the cesarean section rate in China is much higher than the published by the World Health Organization in the Lancet in 2010.AIM To retrospectively analyze the factors related to failed trial of labor and the clinical indications for cesarean section conversion,explore how to promote the trial of labor success rate,and determine the feasibility of reducing the rate of conversion to cesarean section.METHODS A retrospective analysis was performed on 9240 maternal women who met vaginal delivery conditions and required a trial of labor from January 2016 to December 2018 at our hospital.Among them,8164 pregnant women who had a successful trial of labor were used as a control group,and 1076 pregnant women who had a failed trial of labor and converted to an emergency cesarean section were used as an observation group.The patients’clinical data during hospitalization were collected for comparative analysis,the related factors of the failed trial of labor were discussed,and reasonable prevention and resolution strategies were proposed to increase the success rate of trial of labor.RESULTS The analysis revealed that advanced age(≥35 years old),macrosomia(≥4000 g),delayed pregnancy(≥41 wk),use of uterine contraction drugs,primipara,and fever during labor were associated with conversion to an emergency cesarean section in the failed trial of labor.Multivariate regression analysis showed that age,gestational age,primipara,use of uterine contraction drugs,fever duringbirth,and newborn weight led to a higher probability of conversion to an emergency cesarean section in the failed trial of labor.The analysis indicated that the following clinical indications were associated with the conversion to cesarean section in the failed trial of labor:Fetal distress(44.3%),social factors(12.8%),malpresentation(face presentation,persistent occipitoposterior position,and persistent occipitotransverse position)(9.4%),and cephalopelvic disproportion(8.9%).CONCLUSION The conversion to emergency cesarean section in failed trial of labor is affected by many factors.Medical staff should take appropriate preventive measures for the main factors,increase the trial of labor success rate,improve the quality of delivery,ensure the safety of mother and child during the perinatal period,and improve the relationship between doctors and patients.展开更多
China's universal two child policy was released in October of 2015.How would this new policy influence the rate of overall cesarcan delivery(CD)in China?The objective of this paper is to investigate the trend of o...China's universal two child policy was released in October of 2015.How would this new policy influence the rate of overall cesarcan delivery(CD)in China?The objective of this paper is to investigate the trend of overall CD rate with the increase of number of multiparous women based on a big childbirth center of China(a tertiary hospital)in 2016.In this study,22530 cases from the medical record department of a big childbirth center of China from January 1 to December 31 in 2016 were entolled as research objects.Electronic health records of these selected objects were retrieved.According t0 the history of childbirth,the selected cases were divided into primiparous group containing 16340 cases and multiparous group containing 6190 cases.Chi-square test was carried out to compare the rate of CD,neuraxial labor analgesia,maternity insurance between the two groups;1-test was performed to compare the in-hospital days and gestational age at birth between the two groups.Pearson corrclation coefficient was used to evaluate the rclationship among observed monthly rate of multiparas,overall CD rate,and Elective Repeat Cesarean Delivery(ERCD)rate.The results showed that the CD rate in multiparous group was 55.46%,which was higher than that in primiparous group(34.66%,P<0.05).The rate of neuraxial labor analgesia in multiparas group was 9.29%,which was lower than that in primiparas group(35.94%,P<0.05).However,the rate of maternity insurance was higher in multiparas group(57.00%)than that in primiparas group(41.08%,P<0.05).The hospital cost and in-hospital days in multiparas group were higher,and the gcstational age at birth in multiparas group was lower than in primiparas group(P<0.05).The overall CD rate slightly dropped in the first 4 months of the year(P<0.05),then increased from 36.27%(April)to 43.21%(Dcember)(P<0.05).The rate of multiparas women and ERCD had the same trend(P<0.05).There were linear correlations among the rate of overall CD,the rate of multiparas women and the rate of ERCD rate(P<0.05).With the opening of China's two-child policy,the increasing rate of overall CD is directly related with the high rate of ERCD.Trials of Labor After Cesarean Section(TOLAC)in safe mode to reduce overall CD rate are warranted in the future.展开更多
Introduction: Trial of labor after a previous cesarean section (TOLAC) is a method that requires strict monitoring to decrease the cesarean section (CS) rate and improve the maternal and neonatal prognosis. The object...Introduction: Trial of labor after a previous cesarean section (TOLAC) is a method that requires strict monitoring to decrease the cesarean section (CS) rate and improve the maternal and neonatal prognosis. The objective is to determine the profile and outcome of patients with one and two previous CSs who performed TOLAC at Panzi General Referral Hospital. Methodology: This is a cross-sectional study with a prospective collection of data of 111 patients with one and two previous CSs at Panzi Hospital from January 2021 to August 2022. Statistical Package for the Social Sciences SPSS version 23 software was used to analyze the collected data. The percentages of categorical variables were summarized in a frequency table. The mean or median with standard deviation was used to summarize quantitative variables. Results: The overall success rate of the TOLAC was 64%, with 63.8% following one previous CS and 64.3% following two CSs. The mean age of the patients was 27.09 years, with an age range of 25 - 34 years. They were mostly pauciparous (52.2%), married (88.3%), with a high school education (60.4%). The inter-delivery interval > 18 months was noted (64.1%) and overweight in 63.9%. More than three antenatal consultations were performed (58.6%). We found a mean gestational age of 38 (34 - 41) weeks. The perinatal mortality rate was 0.9%. However, we did not record any cases of maternal mortality during the study period. Conclusion: TOLAC after one and two previous CS is implemented in the maternity Unit of Panzi Hospital for well-selected patients. In addition, the success rate is similar after TOLAC with an acceptable maternal-neonatal prognosis.展开更多
Objective: To compare maternal and fetal outcome associated with two methods Reverse breech extraction versus Head pushing to deliver the impacted fetal head in advanced labor requiring emergency Cesarean section. Met...Objective: To compare maternal and fetal outcome associated with two methods Reverse breech extraction versus Head pushing to deliver the impacted fetal head in advanced labor requiring emergency Cesarean section. Method: A prospective comparative study was conducted on 80 pregnant women at term with cephalic presentation in advanced labour, requiring emergency Cesarean Section. Reverse breech extraction technique (pull method) was used in 40 cases (group I) and pushing the head up through the vagina (“push” method) was tried in (group II) 40 cases. The maternal outcome was assessed by extension of the uterine Incision, bladder injury, intra and postoperative blood transfusion, Postpartum hemorrhage, wound infection and duration of hospital stay. Fetal outcome was Apgar score and admission to neonatal intensive care unit. Results: Extension of the uterine incision was significantly lower in women undergoing reverse breech extraction compared to cephalic delivery (20% versus 50%;p = 0.001). The mean operative time (pull group) was lower than that in the (push group) 59.7 ± 4.2, versus 75.2 ± 6.1 p = 0.001 and blood loss was significantly lower in the (pull group) than that in the (push group) 878 ± 67 ml, versus 1321 ± 57 ml, p = 0.001. No significant difference between groups regarding maternal and neonatal outcome. Conclusion: Reverse breech extraction (pull) is safer than pushing head up through vagina (push) for delivery of a deeply impacted fetal head in advanced labour sensitizing emergency Cesarean Section and is associated with the least maternal complications.展开更多
Any non-cephalic presentation in a fetus is regarded as malpresentation.The most common malpresentation,breech,contributes to 3%-5%of term pregnancies and is a leading indication for cesarean delivery.Identification o...Any non-cephalic presentation in a fetus is regarded as malpresentation.The most common malpresentation,breech,contributes to 3%-5%of term pregnancies and is a leading indication for cesarean delivery.Identification of risk factors and a proper physical examination are beneficial;however,ultrasound is the gold standard for the diagnosis of malpresentations.External cephalic version(ECV)refers to a procedure aimed to convert a non-cephalic presenting fetus to cephalic presentation.This procedure is performed manually through the mother’s abdomen by a trained health care provider,to reduce the likelihood of a cesarean section.Studies have reported a version success rate of above 50%by ECV.The main objective of this review is to present a broad perspective on fetal malpresentation,ECV,and delivery of a breech fetus.The focus is to elaborate all clinical scenarios of breech and to provide an evidence-based clinical approach for them.After discussing breech prevalence,risk factors,diagnosis,and management,an updated review of ECV is presented.Moreover,ECV indications/contraindications,alternatives,clinical techniques on how to perform ECV and breech vaginal delivery,and obstetrical considerations for the delivery of malpresentations are thoroughly discussed.展开更多
文摘Objective:To analyze the effect of midwife psychological nursing intervention in the clinical care of elderly women in labor.Methods:According to the order of admission,74 elderly women were divided into the control group and the observation group.In addition to the routine perinatal nursing interventions,the observation group strengthened the implementation of midwives’psychological nursing interventions.The duration of labor,mode of delivery,psychological state,and stress response indexes of the two groups were analyzed and compared.Results:The observation group had a shorter duration of all labor stages and total duration of labor than the control group,a lower cesarean section rate than the control group,and a higher degree of improvement in anxiety,depression,and stress response indexes in the 3-day postpartum period as compared to the control group(P<0.05).Conclusion:The implementation of midwife psychological care intervention in perinatal care of elderly women can further shorten the duration of labor,reduce the cesarean section rate,and improve the psychological state and stress indicators,which is worth promoting.
文摘Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most of obstetricians to increase the num ber of cesarean sections following a previous cesarean section. Guidelines for Vaginal birth after cesarean (VBAC) indicate that TOLAC offers women with no contraindications and one previous transverse low-segment cesarean. The objective of the current study was to study the outcome of trial of labour after caesarean section (TOLAC), the indications for emergency repeat cesarean section and to determine the maternal and fetal prognosis in vaginal birth after caesarian section (VBAC) at Tshikaji Mission Hospital. Patients, Material and Methods: This is a retrospective study of the records of 126 women were selected to undergo the TOLAC in the department of gynecology and obstetrics at the Tshikaji Mission Hospital over the period from January 1<sup>st</sup> to December 31<sup>st</sup>, 2021. The data on demography, antenatal care, labour and delivery and outcomes were collected from the maternity unit of this hospital. The data were analyzed using SPSS version 2.0. Results: The TOLAC in 126 studied women. The course of work allowed vaginal delivery 107 parturient women, a success rate of successful VBAC of 85% after the TOLAC. The repeat emergency cesarean section was necessary for delivery in 15% of cases for failed TOLAC. There was no maternal mortality, but we recorded one fetal death or 0.8% of perinatal mortality, 2 cases of cicatricial dehiscence, the incidence of 1.6%. Maternal morbidity after delivery on cicatricial uterus was dominated by postpartum hemorrhages, with 19 cases or 15.1% of cases. Cervical dilatation of more than 3 cm at the time of admission, the parity more than 3 and were the significant factors in favor of a successful VBAC. Birth weight of more than 3500 g, fetal distress and malpresentation were associated with a lower success rate of VBAC. The TOLAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. Conclusion: Pregnancy on a cicatricial uterus represents a high-risk pregnancy. Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. There is a significantly high vaginal birth after caesarian section (VBAC) success rate among selected women undergoing trial of scar in Tshikaji Hospital. TOLAC remains the option for childbirth in low resource settings as Kasai region in DRC. Adequate patient education and counselling in addition to appropriate patient selection for TOLAC remain the cornerstone to achieving high VBAC success rate.
文摘Background: Cesarean delivery has become the most common major surgical procedure in many parts of the world. Induction of labor in women with prior cesarean delivery is an alternative to mitigate the rising cesarean rates. Objectives: To compare the VBAC success rate between two vaginal forms of dinoprostone for labor induction in women with prior cesarean section. Material and Methods: A pilot study was conducted at a large Governmental Hospital, Dhahran, Saudi Arabia, including 200 women with prior cesarean section and planned for labor induction. Participants were randomly allocated into two groups. Group A (n = 100) received dinoprostone 1.5 mg vaginal tablet. Group B (n = 100) received 10 mg dinoprostone sustained release vaginal pessary. Primary outcome was vaginal delivery rate. Secondary outcomes included maternal and neonatal outcomes. Results: The dinoprostone vaginal tablet and dinoprostone vaginal pessary had a comparable vaginal delivery rate (67% and 64%, respectively;p = 0.78). The median patient satisfaction with the birth process was superior in the dinoprostone vaginal pessary group (p = 0.04). Maternal and neonatal outcomes were similar in both groups. Conclusion: Both forms of dinoprostone were effective methods for labor induction in women with prior cesarean section. However, the patient satisfaction with the birth process was in favor of the dinoprostone sustained release vaginal pessary.
文摘Objective: To review the outcome of prostaglandin induction of labor in term pregnant women with previous one ce-sarean section compared to those without previous Cesarean section. Design: 18 years retrospective review of hospital records and case note review of index cases. Setting: University hospital. Population: Three hundred and twenty two women who had their labor induced with prostaglandin E2. One hundred and sixty one women had one previous Ce-sarean section. Methods: This study was conducted at King Fahad University Hospital, University of Dammam. It is a tertiary referral center with approximately 2300 births per year. We searched the hospital's records of deliveries from January 1992 to December 2009 and reviewed all indications and outcomes of prostaglandin induction of labor in women with one previous Cesarean section. The control group was composed of women who had their labor induced with prostaglandin but without previous Cesarean section. Main outcome measures: Labor outcome and uterine rup-ture Results: Three hundred and twenty two women were included. All received prostaglandin E2 for induction of labor. One hundred and sixty one women had one previous Cesarean section (study group) and the rest had no previous Ce-sarean section (control group). There was no difference in the rate of vaginal delivery between study and control group, 68.3% and 79.5% (p value 0.3), respectively. The rate of uterine rupture was 30 times higher in study group (2.5% Vs 0.033%). Conclusion: In women with one previous Cesarean section, induction of labor with prostaglandin leads to comparable rate of vaginal delivery similar to those without prior Cesarean section but with relatively high risk of uter-ine rupture.
文摘Objective: To evaluate the effect of chewing sugar-free gum on gastrointestinal function recovery after cesarean section. Methods: Randomized controlled trials comparing the use of chewing gum in postoperative recovery with a control group were retrieved from the databases including Pubmed, Cochrane Library, Science Direct, Web of Science, CBM, CNKI, Wanfang and VIP, et al. After screening literatures, evaluating the quality of studies, extracting data, the RevMan5.3 software was used for data analysis. Results: A total of 13 RCTs including 2233 patients were analyzed in the study. The results showed that chewing gum after cesarean delivery can effectively shorten the recovery time of bowel sounds, passage of flatus and first defecation (all P Conclusion: Chewing sugar-free gum after cesarean section can promote the early recovery of gastrointestinal function, but the side effects of chewing gum are still unclear, which needs more clinical, large sample and high-quality studies to further verify.
文摘Background: Cesarean section (CS) has increased steadily over the last decade, with an estimated one-third of women delivering by cesarean section worldwide. Objective: Our study aimed to investigate the demographic and associated factors influencing vaginal birth after one cesarean (VBAC-1) success focusing on variables like pre-pregnancy BMI, diabetes, hypertension, education, and smoking. Study Design and Methods: In this retrospective study, we analyzed 285 cases (81 unsuccessful VBAC-1, 204 successful VBAC-1) from San Juan City Hospital (Puerto Rico) between January 1, 2019, and December 31, 2020. We used odds ratios and model selection comparison to assess the impact of variables on successful VBAC-1, using a significance threshold of 95% CI. Model selection assessed binomial model combinations using a generalized linear approach to identify key risk factors. Results: Unsuccessful VBAC-1 (a repeat cesarean), was associated with diabetes (OR: 0.376, p = 0.086), hypertension (OR: 0.23, p = 0.006), and university-educated women (OR: 1.372, p = 0.711). High school-educated women had an OR of 3.966 (p = 0.105), while overweight women were 0.481 times more likely to have unsuccessful VBAC-1 (p = 0.041). Significant associations were not found with obesity (OR: 0.574, p = 0.122), underweight/normal (OR: 1.01, p = 0.810), or smoking (OR: 1.227, p = 0.990). Conclusion: Results revealed women with higher education levels, hypertension, or diabetes are less likely to have a successful VBAC-1. Understanding the complex interactions affecting these outcomes is aimed at establishing guidelines for healthcare professionals to conduct systematic risk/benefit assessments. This study lays a foundation for evidence-based practices and policies, offering initial insights into VBAC-1 success factors in Puerto Rico.
基金Supported by Liaoning Provincial Natural Science Foundation Guidance Program,No.2019-ZD-1037。
文摘BACKGROUND Vaginal delivery is the ideal mode of delivery for the termination of a pregnancy.However,the cesarean section rate in China is much higher than the published by the World Health Organization in the Lancet in 2010.AIM To retrospectively analyze the factors related to failed trial of labor and the clinical indications for cesarean section conversion,explore how to promote the trial of labor success rate,and determine the feasibility of reducing the rate of conversion to cesarean section.METHODS A retrospective analysis was performed on 9240 maternal women who met vaginal delivery conditions and required a trial of labor from January 2016 to December 2018 at our hospital.Among them,8164 pregnant women who had a successful trial of labor were used as a control group,and 1076 pregnant women who had a failed trial of labor and converted to an emergency cesarean section were used as an observation group.The patients’clinical data during hospitalization were collected for comparative analysis,the related factors of the failed trial of labor were discussed,and reasonable prevention and resolution strategies were proposed to increase the success rate of trial of labor.RESULTS The analysis revealed that advanced age(≥35 years old),macrosomia(≥4000 g),delayed pregnancy(≥41 wk),use of uterine contraction drugs,primipara,and fever during labor were associated with conversion to an emergency cesarean section in the failed trial of labor.Multivariate regression analysis showed that age,gestational age,primipara,use of uterine contraction drugs,fever duringbirth,and newborn weight led to a higher probability of conversion to an emergency cesarean section in the failed trial of labor.The analysis indicated that the following clinical indications were associated with the conversion to cesarean section in the failed trial of labor:Fetal distress(44.3%),social factors(12.8%),malpresentation(face presentation,persistent occipitoposterior position,and persistent occipitotransverse position)(9.4%),and cephalopelvic disproportion(8.9%).CONCLUSION The conversion to emergency cesarean section in failed trial of labor is affected by many factors.Medical staff should take appropriate preventive measures for the main factors,increase the trial of labor success rate,improve the quality of delivery,ensure the safety of mother and child during the perinatal period,and improve the relationship between doctors and patients.
基金This study was supported by the Health and Farmily Planning Commission of Hubei Province(No.WJ2018H0133).
文摘China's universal two child policy was released in October of 2015.How would this new policy influence the rate of overall cesarcan delivery(CD)in China?The objective of this paper is to investigate the trend of overall CD rate with the increase of number of multiparous women based on a big childbirth center of China(a tertiary hospital)in 2016.In this study,22530 cases from the medical record department of a big childbirth center of China from January 1 to December 31 in 2016 were entolled as research objects.Electronic health records of these selected objects were retrieved.According t0 the history of childbirth,the selected cases were divided into primiparous group containing 16340 cases and multiparous group containing 6190 cases.Chi-square test was carried out to compare the rate of CD,neuraxial labor analgesia,maternity insurance between the two groups;1-test was performed to compare the in-hospital days and gestational age at birth between the two groups.Pearson corrclation coefficient was used to evaluate the rclationship among observed monthly rate of multiparas,overall CD rate,and Elective Repeat Cesarean Delivery(ERCD)rate.The results showed that the CD rate in multiparous group was 55.46%,which was higher than that in primiparous group(34.66%,P<0.05).The rate of neuraxial labor analgesia in multiparas group was 9.29%,which was lower than that in primiparas group(35.94%,P<0.05).However,the rate of maternity insurance was higher in multiparas group(57.00%)than that in primiparas group(41.08%,P<0.05).The hospital cost and in-hospital days in multiparas group were higher,and the gcstational age at birth in multiparas group was lower than in primiparas group(P<0.05).The overall CD rate slightly dropped in the first 4 months of the year(P<0.05),then increased from 36.27%(April)to 43.21%(Dcember)(P<0.05).The rate of multiparas women and ERCD had the same trend(P<0.05).There were linear correlations among the rate of overall CD,the rate of multiparas women and the rate of ERCD rate(P<0.05).With the opening of China's two-child policy,the increasing rate of overall CD is directly related with the high rate of ERCD.Trials of Labor After Cesarean Section(TOLAC)in safe mode to reduce overall CD rate are warranted in the future.
文摘Introduction: Trial of labor after a previous cesarean section (TOLAC) is a method that requires strict monitoring to decrease the cesarean section (CS) rate and improve the maternal and neonatal prognosis. The objective is to determine the profile and outcome of patients with one and two previous CSs who performed TOLAC at Panzi General Referral Hospital. Methodology: This is a cross-sectional study with a prospective collection of data of 111 patients with one and two previous CSs at Panzi Hospital from January 2021 to August 2022. Statistical Package for the Social Sciences SPSS version 23 software was used to analyze the collected data. The percentages of categorical variables were summarized in a frequency table. The mean or median with standard deviation was used to summarize quantitative variables. Results: The overall success rate of the TOLAC was 64%, with 63.8% following one previous CS and 64.3% following two CSs. The mean age of the patients was 27.09 years, with an age range of 25 - 34 years. They were mostly pauciparous (52.2%), married (88.3%), with a high school education (60.4%). The inter-delivery interval > 18 months was noted (64.1%) and overweight in 63.9%. More than three antenatal consultations were performed (58.6%). We found a mean gestational age of 38 (34 - 41) weeks. The perinatal mortality rate was 0.9%. However, we did not record any cases of maternal mortality during the study period. Conclusion: TOLAC after one and two previous CS is implemented in the maternity Unit of Panzi Hospital for well-selected patients. In addition, the success rate is similar after TOLAC with an acceptable maternal-neonatal prognosis.
文摘Objective: To compare maternal and fetal outcome associated with two methods Reverse breech extraction versus Head pushing to deliver the impacted fetal head in advanced labor requiring emergency Cesarean section. Method: A prospective comparative study was conducted on 80 pregnant women at term with cephalic presentation in advanced labour, requiring emergency Cesarean Section. Reverse breech extraction technique (pull method) was used in 40 cases (group I) and pushing the head up through the vagina (“push” method) was tried in (group II) 40 cases. The maternal outcome was assessed by extension of the uterine Incision, bladder injury, intra and postoperative blood transfusion, Postpartum hemorrhage, wound infection and duration of hospital stay. Fetal outcome was Apgar score and admission to neonatal intensive care unit. Results: Extension of the uterine incision was significantly lower in women undergoing reverse breech extraction compared to cephalic delivery (20% versus 50%;p = 0.001). The mean operative time (pull group) was lower than that in the (push group) 59.7 ± 4.2, versus 75.2 ± 6.1 p = 0.001 and blood loss was significantly lower in the (pull group) than that in the (push group) 878 ± 67 ml, versus 1321 ± 57 ml, p = 0.001. No significant difference between groups regarding maternal and neonatal outcome. Conclusion: Reverse breech extraction (pull) is safer than pushing head up through vagina (push) for delivery of a deeply impacted fetal head in advanced labour sensitizing emergency Cesarean Section and is associated with the least maternal complications.
文摘Any non-cephalic presentation in a fetus is regarded as malpresentation.The most common malpresentation,breech,contributes to 3%-5%of term pregnancies and is a leading indication for cesarean delivery.Identification of risk factors and a proper physical examination are beneficial;however,ultrasound is the gold standard for the diagnosis of malpresentations.External cephalic version(ECV)refers to a procedure aimed to convert a non-cephalic presenting fetus to cephalic presentation.This procedure is performed manually through the mother’s abdomen by a trained health care provider,to reduce the likelihood of a cesarean section.Studies have reported a version success rate of above 50%by ECV.The main objective of this review is to present a broad perspective on fetal malpresentation,ECV,and delivery of a breech fetus.The focus is to elaborate all clinical scenarios of breech and to provide an evidence-based clinical approach for them.After discussing breech prevalence,risk factors,diagnosis,and management,an updated review of ECV is presented.Moreover,ECV indications/contraindications,alternatives,clinical techniques on how to perform ECV and breech vaginal delivery,and obstetrical considerations for the delivery of malpresentations are thoroughly discussed.
