Caesarean Section Including Uterine Rupture and Full Dilatation Caesarean Deliveries

Exploring full cervical dilatation caesarean sections–A retrospective cohort study

A temporary inferior vena caval filter: the way forward in prophylaxis against pulmonary embolism?

Caesarean section at full cervical dilatation has many implications for maternal and neonatal morbidity as well as subsequent pregnancy outcomes. However, increasing trends are reported internationally for second-stage caesarean delivery. To review the rate and indication for a caesarean section at full dilatation over a 5-year period at a tertiary referral obstetric centre in Sydney. Retrospective cohort review of all women with a singleton, cephalic presenting fetus at ≥37(0) weeks' gestation delivered by caesarean section in the second stage of labour between 1 January 2009 and 31 December 2013 at Royal Prince Alfred Hospital. Medical records were reviewed, and demographic, maternal and fetal outcome data were obtained. Consultant supervision and documentation standards were recorded. The main outcome measures were the rate of caesarean section at full cervical dilatation, maternal and fetal morbidity. During the study period, 8449/26063 (32.4%) babies were born by caesarean section. Of these surgical births, 476 (5.6%) were performed at full cervical dilatation at >37weeks' gestation. There was no observed trend over the 5years. The majority of women delivered by caesarean section at full dilatation were nulliparous and in spontaneous labour. More than half of these women were delivered without a trial of instrumental delivery. Consultant obstetricians were present for 7% of public second-stage caesarean deliveries. We report a 5-year experience with caesarean delivery at full dilatation at a tertiary unit. The rate was variable over the 5years. Secondary outcome measures suggest that consultant supervision is uncommon and documentation standards require improvement.

792: Maternal & fetal morbidity due to abdominal adhesions after repeated cesarean section

Background: Uterine rupture is a rare, but dangerous obstetric complication that can occur during trial of vaginal birth. Methods: The aim of this study was to evaluate the relationship between peripartum infection at the first caesarean delivery to uterine dehiscence or rupture at the subsequent delivery. We conducted a retrospective case-control study from March 2014 to October 2020 at a single academic medical center. The study group included women with a prior caesarean delivery and proven dehiscence or uterine rupture diagnosed during their subsequent delivery. The control group included women who went through a successful vaginal birth after cesarean section (VBAC) without evidence of dehiscence or uterine rupture. We compared the rate of peripartum infection during the first cesarean delivery (CD) and other relevant variables, between the two groups. Results: A total of 168 women were included, 71 with uterine rupture or dehiscence and 97 with successful VBAC as the control group. The rate of peripartum infection at the first caesarean delivery was significantly higher in the study group compared to the control group (22.2% vs. 8.2%, p = 0.013). Multivariate logistic regression analysis found that peripartum infection remained an independent risk factor for uterine rupture at the subsequent trial of labor after CD (95% confidence interval, p = 0.034). Conclusion: Peripartum infection in the first caesarean delivery, may be an independent risk-factor for uterine rupture in a subsequent delivery.

Long-term implications of cesarean section

Context and Objective: Continued increases in the number of births by caesarean section in many countries of the world, have influenced at increased the number of uterine rupture. The purpose of this paper is to determine the correlation between births by caesarean section and uterine rupture. Design and Setting: Cross-sectional study. Designed as a pre-defined protocol and a search was conducted by non-electronic databases (with the written-protocol of the births) of Obstetrics and Gynaecology Clinic/University Clinical Centre of Kosovo. Methods: Data for uterine rupture were collected for five years (from 2010 to 2014), only in women who gave birth by caesarean section. The cases with uterine rupture have divided over the years, as has happened rupture, then are made statistical calculations. Results: Of the twenty-two cases reported with uterine rupture during five years at the Department of Obstetrics and Gynaecology, were counted in all cases (100 per cent). They were twenty-two cases of uterine rupture by the total 15526 women that have born by Caesarean Section during five years. Calculation of incidence has come out that is 14 per 10,000 deliveries with Caesarean Section and significance level for observed proportion was P<0.0001 (95% confidence interval CI; 21.35 to 22.66). From 2010 to 2014, have a continuous increase of uterine rupture, if we make a comparison the percentage of uterine rupture of 2010, with a percentage of 2014, have a significant difference (in favor of the increase); 0.07 % versus 0.17%, odds ratio OR=0.82 (95% Cl; 0.016 to 41.70). Conclusions: We conclude that as much as increases number of the births with caesarean delivery, will increase the cases with uterine rupture. The incidence rates of the uterine rupture in Kosovo are 14 per 10,000 deliveries with Caesarean Section (as estimated by this study five old; 2010 to 2014). Key words: caesarean section, uterine rupture, Kosovo.

Obstetric anesthesia in China: associated challenges and long-term goals.

Reflections on a Decade of Outcomes Management in Women's Services

<h3>Introduction</h3> Intrapartum caesarean delivery (CD) is a common obstetric intervention. Published cohorts report up to 31,2% of intrapartum CD among parturients admitted to delivery room.¹ It also represents 60 to...

This study examined physicians' propensity for caesarean deliveries at solo versus group practice obstetrics/gynaecology (ob/gyn) clinics in Taiwan. We used population-based (National Health Insurance) claims data covering all 253 618 singleton deliveries conducted at ob/gyn clinics, during 2000-02. The dependent variable, delivery mode, was treated as dichotomous [caesarean section (CS) = 1, vaginal delivery (VD) = 0]. The independent variable of interest was practice size, classified into four categories: 1, 2, 3 and 4+ physicians. Multilevel logistic regression modelling, accounting for clinic-level variation in CS rates, was used to examine CS likelihood by practice size, among the total delivery sample and among the sub-samples disaggregated by obstetric complication status. Solo practices have 7% excess caesarean cases relative to large group practices. After controlling for patient's age, physician demographics, the clinic's geographic location and size of delivery service, and clinic-level random effect, solo practice physicians were 5.38 times as likely as 4+ physician practices to provide caesarean delivery (CI = 4.18 approximately 6.93), 2-physician practices were 3.87 times (CI = 2.99 approximately 5.01) and 3-physician practices 2.72 times (CI = 2.06 approximately 3.59) as likely as 4+ physician practices to provide caesarean delivery. This effect is driven by higher CS propensity among solo and small groups among cases with obstetrically less salient complications and the 'no complications' subset of patients. Wide confidence intervals for odds ratios in these sub-samples also attest to wide variations in clinic-level CS rates among these patient groups. Solo physicians are the most likely to provide caesarean delivery, and CS likelihood decreases with increasing number of physicians in the practice. Group practice support may reduce the CS likelihood, when it is not clinically indicated. Policy makers should consider initiatives to limit full service delivery privileges to group practice obstetric clinics, in order to reduce unnecessary CS. Solo practice clinics should, at best, be licensed as birthing centres, required to transfer patients needing CS to a larger facility.

Risk of spontaneous preterm birth elevated after first cesarean delivery at full dilatation: a retrospective cohort study of over 30,000 women

Objectives To audit caesarean sections performed at full cervical dilatation over a three year period in a tertiary referral centre in Ireland. To evaluate (i) the rate of caesarean deliveries in the second stage of labour, (ii) the indication for delivery and (iii) the associated fetal and maternal morbidity in this cohort of women. Study design This cohort study was carried out in the University Hospital Galway (UHG). Medical records of 136 consecutive women with singleton cephalic pregnancies at term, identified from the hospital database, who underwent a second stage caesarean section (CS) between 1 January 2006 and 31 December 2008, were reviewed retrospectively and demographic and outcome data were collected. Results During the study period 2801/10,202 (27.5%) babies were delivered by CS. One hundred and thirty six CS (4.8%) were performed at full dilatation. The rate of CS during the second stage increased from 0.9% in 2006 to 1.8% in 2008. The majority of women were nulliparous (76.5%) and in spontaneous labour (64%). 44.1% of women had a second stage CS without a trial of instrumental delivery. 41.3% of public deliveries were attended by a consultant. The majority of babies (54%) were delivered because of a prolonged second stage with a mean duration of 146 min from full dilatation to delivery. Twenty-four of 59 primiparous women (40.7%), who underwent CS because of a prolonged second stage, did not receive oxytocin. 13.2% of babies were admitted to the neonatal intensive care unit. Estimated blood loss was documented in 67% of cases (n = 91); 14.3% of women (n = 13) had a postpartum haemorrhage greater than or equal to 1000 mls. 23% of these women (n = 3) required a blood transfusion. The overall blood transfusion rate was 2.2%. 50% of women had a hospital stay of greater than four days. Conclusions There is a worrying rise in the overall rate of CS at full dilatation. Audit of the second stage CS rate is a useful measure of clinical standards. Strategies for improved care include increased consultant presence, meticulous documentation and ongoing training of junior obstetric staff to ensure safe intrapartum care. Condensation The increase of second stage caesarean sections requires urgent strategies for improved care including increased consultant presence, meticulous documentation and training of junior obstetric staff.

Early first-trimester transvaginal ultrasound is indicated in pregnancy after previous Cesarean delivery: should it be mandatory?

Term full dilatation cesarean delivery (FDCD) is associated with an increased risk of subsequent spontaneous preterm birth (sPTB). The impact of preterm FDCD on recurrent sPTB is unknown. We investigated the relationship between recurrent sPTB and the mode of prior sPTB. This is a retrospective cohort study of singleton pregnant women attending two high-risk preterm birth surveillance clinics (University College London Hospital and St Thomas' Hospital London, UK), with one previous sPTB (24-36 + 6 weeks). Women were categorized according to their mode of birth in the index sPTB pregnancy: (1) preterm FDCD, (2) preterm vaginal birth and (3) preterm cesarean delivery at <10 cm cervical dilatation (CD < 10 cm). The primary outcome was recurrent sPTB <37 weeks of gestation. Secondary outcomes included sPTB <34 weeks, <28 weeks, spontaneous late miscarriage and short cervical length (≤25 mm). In a subgroup of women with preterm FDCD, CD scar characteristics were assessed during the second trimester of pregnancy using transvaginal ultrasound. Median gestation of prior sPTB was similar across all groups (32 weeks; p = 0.454). Recurrent sPTB <37 weeks was significantly more common in women with previous preterm FDCD, 38.1% (8/21) compared to vaginal birth, 15.1% (16/106) or CD < 10 cm, 13.8% (15/109); aOR 4.4 (95% CI 1.3-14.9; p = 0.023) and 5.1 (95% CI 1.6-16.5; p = 0.022), respectively. Recurrent sPTB <34 weeks was even higher in the previous preterm FDCD group, 23.8% (5/21) compared to vaginal birth 4.7% (5/106) or CD < 10 cm 8.3% (9/109); aOR 16.6 (95% CI 2.8-97.2; p = 0.016) and 5.7 (95% CI 1.4-23.1; p = 0.022), respectively. CD scar location was assessed in 15 women with preterm FDCD in one centre. Scar visualization was 87%, with 77% (10/13) of scars being located within the cervix or <5 mm above the internal cervical os. Women undergoing FDCD following preterm labor have a significantly higher risk of recurrent sPTB at <37 and <34 weeks of gestation compared to women with previous preterm vaginal birth or CD prior to the second stage of labor. These findings suggest that preterm FDCD may further compromise cervical function. It is important that clinicians are aware of this increased risk of recurrent sPTB to guide patient counseling and management accordingly.