Cesarean Section In Subsequent Pregnancy Research Articles

Survival and fertility of bitches undergoing caesarean section

BackgroundWith the increasing popularity of planned caesarean section, the need for knowledge regarding this surgery has become increasingly important. The reported death and survival rates for caesarean sections vary widely....

Labour pain perception and use of non-pharmacologic labour support in newly delivered mothers in Ibadan, Nigeria

Background: Pain is an unpleasant and highly personal experience that may be imperceptible to others. It is a common experience in labour and childbirth. Dealing with labour pain remains a concern to women in labour, as well as skilled birth attendants, especially in poor/low-resource settings where pain management protocol is nonexistent or where there may be sociocultural constraints of pain relief methods. Aim: To explore labour pain perception and the use of non-pharmacologic support during labour among newly delivered mothers. Method: A cross-sectional descriptive design was adopted in assessing 100 newly delivered mothers at University College Hospital and Jericho Nursing Home in Ibadan, Nigeria. Three hypotheses were generated and tested at alpha5%. These were that there is no significant difference between: provision of information and perception of pain during labour among newly delivered mothers; labour pain experience and choice for caesarean section in subsequent pregnancies; and back massage and pain reduction during labour. Results: About 96% of women indicated that they experienced pain during labour. All the respondents acknowledged that labour pain was a normal experience every woman should go through. However, some women (68%) indicated a need to relieve labour pain. About 60% preferred to be supported in labour, and non-pharmacological support, which was experienced by around 70%, was identified as mainly emotional (52%) and massage therapy (32%). There was low preference for spouses’ emotional support (37%). Caesarean section was not considered as an alternative to experiencing labour pain by 62% of respondents. There were significant associations between information and pain perception during labour (p=0.017); labour pain experience and choice of caesarean section in subsequent pregnancies (p=0.002); and back massage and pain reduction during labour (p=0.008). Conclusion: Labour pain is a serious issue that may break the tradition of and clamour for spontaneous vaginal delivery in the Nigerian setting. Information and support during labour helped women to cope. Assessment should be imbibed by nurses and midwives in labour wards for accurate diagnosis and management of pain in labour. Spousal support during labour should be encouraged.

Pregnancy and coarctation of the aorta

Discussing the management of coarctation of the aorta in pregnancy, Dr Venning and her colleagues (May 2003 JRSM1) emphasize the importance of close monitoring, control of hypertension and a multidisciplinary approach. We agree absolutely; but we disagree with their recommendation that 'elective caesarean section be performed in such cases to avoid the second stage and to reduce the need for Valsalva manoeuvres...'. We have cared jointly for many parturients with cardiac disease, including coarctation and Marfan's syndrome, and unless the mother or fetus is in imminent danger we recommend vaginal delivery with low-dose epidural analgesia, and elective instrumental delivery without maternal pushing in the second stage, to avoid Valsalva manoeuvres. This avoids the risks associated with caesarean section—namely, bleeding, deep vein thrombosis, infection, the need for intravenous Syntocinon (oxytocin) with its potential for adverse cardiovascular effects, and an increased requirement for caesarean section in subsequent pregnancies. Furthermore, both regional anaesthesia (which we prefer) and general anaesthesia for caesarean section are more likely to induce cardiovascular instability than low-dose epidural analgesia in labour. If caesarean section is required, the epidural can be readily extended in most cases. In the past, elective caesarean section (usually under general anaesthesia) was the mode of delivery for many women with cardiac disease, but there is increasing evidence that vaginal delivery with regional analgesia can produce a good outcome.2 Elective caesarean section may be desirable in the occasional patient with coarctation and uncontrollable systemic hypertension, marked aortic root dilatation and/or severe residual or native coarctation,3 although supportive data for this approach are clearly required.

Management of unscarred ruptured uterus.

Rupture of an unscarred gravid uterus is a rare and dangerous event. We carried out a postal questionnaire survey of the Fellows of the Royal College of Obstetricians and Gynaecologists (United Kingdom), to ascertain the past and present management policies in such an event. 210 Fellows responded (43.5%) and 85 of them managed at least one case of uterine rupture in previously unscarred gravid uterus. A total of 108 cases were reported of which 74 (68.5%) were diagnosed during labor. The tear was repaired and the uterus conserved in 56.5% cases. Maternal mortality was 10.2% (95% CI 5.2, 17.5) and perinatal mortality was 34.3% (95% CI 25.4, 44). When asked how they would manage such a case in the absence of life threatening circumstances in future, 80.8% of Fellows would opt for uterine repair. Fellows with previous hands-on experience of uterine rupture would involve urologists more often in operative management (22% v 8%, OR 3.4, 95% CI 1.2, 10.1). 48% of Fellows felt that in-patient management is indicated in subsequent pregnancies and 91% would perform an elective cesarean section in subsequent pregnancy.