Cesarean Section Procedure Research Articles

Antibiotic Use in Cesarean Section and Hysterectomy Procedure: Qualitative and Quantitative Assessment

Antibiotic resistance is global issue and the incident is increasing with the use of unwise antibiotic. This study is to describe and evaluate appropriateness of antibiotic prophylaxis selection on Cesarean Section and Hysterectomy procedure. Purpose of study is to evaluate appropiateness of antibiotic selection on cesarean section and hysterectomy. A retrospective study was performed during September 2016 - January 2017 in Private Hospital, Semarang. Data were analized quantitatively using ATC-DDD methodology. Evaluation of antibiotic prophylaxis will be assessed based on The guideline of The American College of Obstetricians and Gynecologists (ACOG) : Antibiotic Prophylaxis for Gynecologic Procedures and The American Society of Health-System Pharmacists (ASHP) : Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery. Overall, 90 of 95 patients were given antibiotic prophylaxis. The most frequently used antibiotics were ceftriaxone (69.51 DDD/Patient-days) and ceftazidime (14.95 DDD/Patient-days). Appropriate antibiotic selection based on the guidelines for cesarean section procedure was 1.75% and 6.1% for hysterectomy procedure. The use of antibiotic prophylaxis on cesarean section and hysterectomy procedure was very high and less appropriate in the selection. Almost patient received third-generation cephalosporin instead of first-generation cephalosporin such as cefazolin. cefazolin is more effective and narrow spectrum for infection-causing bacteria of these procedures.

Spinal Anesthesia in Patient with Congestive Heart Failure due to Congenital Atrial Septal Defect, and Pulmonary Hypertension Undergoing Cesarean Section Procedure: A Case Report

Introduction. In patients suffering from heart disease, pregnancy is a risk factor for mortality. Heart disease in pregnant women can be in form of rheumatic heart disease, cardiomyopathy, or congenital heart disease. This case report is about the successful spinal anesthesia technique in cesarean section (C-section) patients with congestive heart failure due to congenital atrial septal defect, and pulmonary hypertension (PH).
 Case presentation. A pregnant woman, 24 years old, planned to have an emergency C-section. She complained about shortness of breath for 2 days before admission. Three months ago, the patient started to feel shortness of breath during activity and also complained her legs swelled. She has a history of congenital heart i.e. atrial septal defect (ASD), but not routinely been treated. Her examination showed tachypnea, murmur, bibasilar fine crackles lung sound, and pretibial pitting edema. Echocardiography showed ASD with pulmonary hypertension. Spinal Anesthesia using 0.5% isobaric bupivacaine 7.5 mg and fentanyl 25 µcg was given before surgery. Drugs was injected in L3-L4 level with the upper target was as high as T6. the head position is raised 30 degrees. Procedure went well and the APGAR score was 8/9, Patient was admitted to the ICU for one day and discharged from hospital at the 5 days of hospital care.
 Conclusion. Spinal single-shot spinal anesthesia with small doses of bupivacaine and adjuvant can be used as an alternative technique in emergency C-section for patients with congestive heart failure due to congenital atrial septal defect, and pulmonary hypertension.

Acute postoperative pain in 23 procedures of gynaecological surgery analysed in a prospective open registry study on risk factors and consequences for the patient

Effective perioperative pain management is essential for optimal patient recovery after surgery and reduces the risk of chronification. However, in clinical practice, perioperative analgesic treatment still needs to be improved and data availability for evidence-based procedure specific analgesic recommendations is insufficient. We aimed to identify procedures related with high pain scores, to evaluate the effect of higher pain intensity on patients and to define patient and intervention related risk factors for increased pain after standard gynaecological and obstetrical surgery. Therefore, we performed a prospective cross-sectional study based on the German registry for quality in postoperative pain (QUIPS). A cohort of 2508 patients receiving surgery between January 2011 and February 2016 in our tertiary referral centre (university departments of gynaecology and obstetrics, respectively) answered a validated pain questionnaire on the first postoperative day. Maximal pain intensity was measured by means of a 11-point numeric rating scale (NRS) and related to procedure, perioperative care as well as patient characteristics. The interventions with the highest reported pain scores were laparoscopic removal of ovarian cysts (NRS of 6.41 ± 2.12) and caesarean section (NRS of 6.98 ± 2.08). Factors associated with higher pain intensity were younger age (OR 1.75, 95% CI 1.65–1.99), chronic pain (OR 2.08, 95% CI 1.65–2.64) and surgery performed outside the regular day shift (OR 1.67, 95% CI 1.09–2.36). Shorter duration of surgery, peridural or local analgesic and preoperative sedation reduced postoperative pain. Patients reporting high pain scores (NRS ≥ 5) showed relevant impairment of daily activities and reduced satisfaction. Caesarean section and minimal invasive procedures were associated with the highest pain scores in the present ranking. Pain management of these procedures has to be reconsidered. Younger age, receiving surgery outside of the regular shifts, chronic pain and the surgical approach itself have a relevant influence on postoperative pain intensity. When reporting pain scores of 5 or more, patients were more likely to have perioperative complications like nausea or vomiting and to be impaired in mobilisation. Registry-based data are useful to identify patients, procedures and critical situations in daily clinical routine, which increase the risk for elevated post-intervention pain. Furthermore, it provides a database for evaluation of new pain management strategies.

Effect of Intraveous Tranexamic Acid and Sublingual Misoprostol on Reducing Post Cesarean Section Bleeding

Background and Aim: Cesarean section rates are rising around the globe and are considered as the major surgical procedure conducted on females. Cesarean-related hemorrhage contributes to increasing mortality rates around the world. Due to the rise in cesarean rate and its associated complications, post-cesarean severe bleeding without proper management is a major concern. Therefore, the present study aimed to assess the intravenous tranexamic acid (TA) and sublingual misoprostol effect on reducing post-cesarean section bleeding. Materials and Methods: This cross-sectional study was conducted on 146 term pregnant women undergoing emergency or elective cesarean section at the Department of Obstetrics and Gynaecology, Qazi Hussain Ahmad Medical Complex, Noshehra during the period from 7th September 2020 to 6th March 2021. All the participants were randomly categorized into two groups. Each group comprised of 73 participants whereas groups I and II received sublingual misoprostol (600 µg) and 500 mg intravenous tranexamic at card clamping respectively. Both groups were administrated for postoperative 48 hours and blood loss was measured. The packed cell volume and postoperative Hb were evaluated and compared with initial values before surgery. The need for blood transfusion, drug side effects, and additional uterotonics was evaluated. SPSS version 20 was used for data analysis. Results: The mean age of groups I and II were 28.32±4.73 and 28.17±4.83 years whereas the overall mean age was 28.25±4.78years. A higher reduction of hemoglobin level was observed in an intravenous tranexamic group compared to the sublingual group (-2.39±0.93 versus -2.09±1.28g/dL) (p=0.001). Moreover, the intravenous tranexamic group had significantly higher blood suction and gauze usage than sublingual misoprostol (256.73± 83.25versus 189.68± 102.4 cubic centimeter (cc) and 4.59±1.43 versus 3.19±1.27) for a significant value of 0.001. The decrease in mean blood pressure during the cesarean section procedure was significant in intravenous tranexamic than sublingual misoprostol (p=0.001). Conclusion: Our study concluded that sublingual misoprostol significantly reduced total bleeding when compared to tranexamic acid. Furthermore, hemodynamic variables were stabilized more in the misoprostol group than in the tranexamic acid group. Keywords: Cesarean Section Bleeding; Intravenous Tranexamic acid; Sublingual misoprostol.

Caesarean section rates in primigravid women categorised by age and BMI

The rising caesarean section (CS) rate is a complex issue, particularly in an increasingly heterogenous nulliparous population. The study aim was to stratify the CS rate in nulliparous women by age and BMI to determine if any difference existed. This was a retrospective review of CS procedures of nulliparous women in two centres in Ireland (2014 through 2017). Data were obtained for 17,177 women from the hospital databases and CS procedures determined for each age and BMI category. Significant differences were observed when CS rates were stratified in this manner. The CS rates for women <20 years/BMI < 18.5 was 8.8 versus 57.6% for women 35 − 39 years/BMI 30 − 34 and 76 − 100% for all women >45 years (p<.005). The development of customised charts subdivided by age and BMI may be a useful counselling tool and assist in the comparison of rates between units. Impact statement What is already known on this subject? It is well known that along with rising CS rates globally, there have also been significant changes in maternal demographics—with increasing maternal age at first birth and increasing maternal BMI. It is well established that both of these factors affect the rate of CS in a population. What do the results of this study add? This study sought to stratify the CS rate in nulliparous women by age and BMI to determine if any difference existed. The results of the study showed an increasing CS rate for increasing age and BMI categories that was statistically significant. What are the implications of these findings for clinical practice and/or further research? Additional research using larger population data sets could allow the development of customised charts for nulliparous women subdivided by age and BMI which could act as a useful counselling tool in clinical practice, as well as assist in the comparison of CS rates between units.

Factors Contributing to the Increase of Caesarean Section Among Members of National Health Insurance in Indonesia

Every member of the National Health Insurance has the right to get the benefits package according to medical indications and service standards, not at their request. Nevertheless, by many scholars, it is considered ambiguous in reviewing the increasing utilization of caesarean section procedures because of the absence of guideline-defined indications of caesarean sections in Indonesia, which leads to the question of whether it is guideline-defined indications, doctor-defined indications, or maternal request. This study fills this research gap by identifying predisposing, enabling and need factors on the actual behaviour of caesarean section based on the Health-Seeking Behaviour model. Data for the study were obtained through a purposive sample of 564 postpartum women in three provinces. We used logistic regression models to examine factors influencing the caesarean section among NHIS' members. This study highlights self-rated health, religion, non-employee (BP), and moderate-socioeconomic (C status) influence the increasing caesarean section among mothers in the context of the NHI scheme. The most important finding from this study is that individuals in self-rated health with good conditions were also more likely to choose a caesarean section. Implications for consumers education and suggestions for future research are discussed. Keywords: education, enabling factors, Health-Seeking Behaviour, need factors, predisposing factors, self-rated health. DOI: 10.7176/EJBM/13-20-02 Publication date: October 31 st 2021

Diagnostic Test On Modified Score Of Cesarean Section History In Placenta Accreta Index In Predicting Placenta Accreta Diagnosis In Rsup Dr M Djamil

Introduction : Placenta accreta is defined as abnormal implantation of placenta villi which invades myometrium without the presence of decidua bacalis resulting in placenta that is difficult to remove. Based on the depth of invasion, placenta accreta is divided into three grades, placenta accreta, placenta increta, and placenta percreta. Placenta accreta developes if chorionic villi attaches to endometrium beyond desidua basalis. Placenta increta develops when chorionic villi invades the whole myometrium. Placenta percreta developes when chorionic villi attaches beyond myometrium reaching serous and abdominal organ. Based on clinical manifestation, placenta accreta is the common term being used. Incident of abnormal placenta invasion varies from 1 : 93.000 up to 1 : 540 pregnancy. PA incidence had increased four times from 1994 to 2002 in line with increased of caesarean section procedure. Other study showed history of caesarean section increased risk of placenta accreta up to 8,7 times. Placenta accreta index (PAI) was developed based on scoring process or various parameters assessment to help diagnose placenta accreta. The parameters including: history of caesarean section ≥ 2 times, lacunae grade, sagittal smallest myometrial thickness, anterior placenta previa and birding vessel. High PAI indicates high risk of abnormal placenta invasion based on histology.Objective : This study aims to investigate modified history of cesarean section score in placenta accreta index in predicting placenta accreta diagnosis in RSUP DR M Djamil Padang.Material and methods : This was analytical study with cross sectional design. Study population was 84 placenta accreta patients in RSUP Dr. M. Djamil Padang from 2016 to 2019. Study sample was recruited using simple random sampling technique after meeting inclusion and exclusion criteria. Statistic analysis was done using Cohen’s Kappa test. Diagnostic test including sensiticivy, specivicity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy.Result : Strenght of agreement diagnosis placenta accreta based on PAI showed Kappa score of -0,002 (Kappa score &lt; 0,2) which indicated poor strength of agreement. Strenght of agreement diagnosis placenta accreta based on modified PAI showed Kappa score of 0,353 (Kappa score range from 0,21 to 0,40) which indicated fair strength of agreement. PAI diagnostic test yield sensitivity of 97,1%, specificity of 2,8%, positive predictive value of 48,5%, negative predictive value of 50%, and accuracy of 48,6%. Modified PAI diagnostic test yield sensitivity of 97,1%, specificity of 38,9%, positive predictive value of 60%, negative predictive value of 93,3%, and accuracy of 67,1%.Conclusion : PAI has high sensitivity, low specificity, moderate positive predictive value, moderate negative predictive value, and moderate accuration. Modified PAI has high sensitivity, moderate specificity, moderate positive predictive value, high negative predictive value, and high accuracy. PAI diagnosis has poor strength of agreement compared with pathology anatomy. Modified PAI diagnosis has fair strength of agreement compared with pathology anatomy. Modified PAI has identical sensitivity with standard PAI, meanwhile for specificity, positive predictive value, negative predictive value, and accuracy, modified PAI yields higher result compared to PAI.Keywords: Modified score of history caesarean section, placenta accreta index, Modified placenta accreta index, diagnostic test of placenta accreta diagnosis

Pregnant women's knowledge, perception and attitudes towards caesarian section among obstetrics unit attendants in a teaching hospital

Background: This study investigated pregnant women's knowledge level, perception and attitudes towards caesarean section in the Obstetrics Unit at the Korle-Bu Teaching Hospital.Methods: We employed a descriptive cross-sectional survey design to conduct the study.Results: The findings of the study revealed that majority (82.2%) of pregnant women have considerable knowledge about conditions that predisposes a woman for caesarean section as well as the risk of complications. Factors which significantly encouraged respondents to undergo caesarean section deliveries were they being necessary to protect the health of their babies (85.8%), having more knowledge about caesarean section procedures and risks and trusting in the competence of the doctor (53%). On the other hand, the study identified some inhibiting factors such as 67% of women perceive that caesarean sections take away the joy of a woman, while giving birth. Respondents (56%) however, indicate that caesarean sections were not unnatural nor only reserved for those with medical issues or those who fear pain; they are not embarrassing to reveal to family, friends, etc.Conclusion: In the case of a tertiary hospital in Ghana, women attending antenatal clinic have acquired adequate knowledge and fairly good attitudes and perceptions about caesarean section, its benefits and possible complications. The findings of this study have important policy and practical implications for other levels hospitals.

Post cesarean section surgical site infection and associated factors among women who delivered in public hospitals in Harar city, Eastern Ethiopia: A hospital-based analytic cross-sectional study.

Cesarean section (CS) is often complicated by surgical site infection (SSI) that may happen to a woman within 30 days after the operation. This study was conducted to estimate the prevalence of SSI and identify the factors associated with SSI. A hospital-based analytic cross-sectional study was conducted based on the review of medical records of 1069 women who underwent CS in two public hospitals in Harar city. The post-CS SSI is defined when it occurred within 30 days after the CS procedure. Factors associated with SSI were identified using a multivariable binary logistic regression analysis. The analysis outputs are presented using an adjusted odds ratio (aOR) with a corresponding 95% confidence interval (CI). All statistical tests are defined as statistically significant at P-values<0.05. The prevalence of SSI was 12.3% (95% confidence interval (CI): 10.4, 14.4). Emergency-CS was conducted for 75.9% (95% CI: 73.2, 78.3) of the women and 13.2% (95% CI: 11.3, 15.4) had at least one co-morbid condition. On presentation, 21.7% (95% CI: 19.3, 24.3) of women had rupture of membrane (ROM). Factors significantly and positively associated with post-CS SSI include general anesthesia (aOR = 2.0, 95%CI: 1.10, 2.90), ROM (aOR = 2.27, 95%CI: 1.02, 3.52), hospital stay for over 7 days after operation (aOR = 3.57, 95%CI: 1.91, 5.21), and blood transfusion (aOR = 4.2, 95%CI: 2.35, 6.08). The prevalence of post-CS SSI was relatively high in the study settings. Screening for preoperative anemia and appropriate correction before surgery, selection of the type of anesthesia, close follow-up to avoid unnecessary prolonged hospitalization, and careful assessment of membrane status should be considered to avoid preventable SSI and maternal morbidity.

Perbedaan Lama Dirawat Pasien Umum dan Pasien BPJS dengan Prosedur Tindakan Caesarean Section di RSIA Dian Pertiwi Karanganyar Tahun 2019

Problems that emerged at RSIA Dian Pertiwi Karanganyar were the length of treatment for general patients and BPJS patients with caesarean section procedures. There was a difference in the average length of stay for general patients by 4 days while BPJS patients are 3 days. Data collection was carried out observational by reviewing inpatient documents on general patient data and BPJS patient data with the caesarean section procedure from the RM sheet 1 summary form of admission and exit of inpatients. The approach method used is retrospective. The results of the analysis of the Mann-Whitney statistical test (0.001 &lt;0.05) so that it can be concluded that there was a significant difference in the length of stay of general patients and BPJS patients with the caesarean section procedure.

The Effect of Hypnotherapy on Postpartum Pain and Depression in Women with Post Caesarean Delivery

Background: Postoperative pain is one of the most common problems in women after cesarean section. Caesarean section is also associated with post-partum depression. Hypno­therapy is one of the complementary therapy options that are effective and efficient in reducing pain symptoms and post-partum depression. This study aimed to analyze the effect of hypnotherapy on the level of pain and post-partum depression in post-cesarean section patients. Subjects and Method: This was an expe­rimental single-blind randomized controlled trial with a post-test group design, which was conducted from January to April 2021, at the Dr. Moewardi and Universitas Sebelas Maret Hospitals, Surakarta. A sample of 80 patients with cesarean section was divided into two groups, namely 40 pati­ents in the hypno­therapy group and 40 patients in the control group. The indepen­dent variable was hypno­therapy. The depen­dent variables were pain and depression. Hypnotherapy was carried out by self-hypnosis using audio recordings of hypnotherapy in 2 sessions before and after the cesarean section procedure. The pain was measured by the Numeric Rating Scale. Post-partum depression was measured by the Edinburgh Postnatal Depression Scale. The data were analyzed by an independent t-test. Results: Post-cesarean section pain in the group of hypnotherapy (Mean= 4.58; SD= 1.20) was lower than without hypnotherapy (Mean= 6.48; SD= 1.01), and it was statis­tically significant (p<0.001). Postpartum de-pression in the group of hypnothera­py (Mean= 6.08; SD= 1.60) was lower than non-hypnotherapy group (Mean= 8.48; SD= 3.78), and it was statis­tically significant (p <0.001). Conclusion: Hypnotherapy has a significant effect on reducing pain and post-partum depression in post-cesarean section patients. Keyword s : Hypnotherapy, pain levels, post-partum depression, post-cesarean section Correspondence: Araafi Hariza Mahandaru. Department of Obstetrics and Gynecology, Faculty of Medi­cine, Universitas Sebelas Maret/ Dr. Moe­wardi Hospital, Surakarta, Jl. Kolonel Sutar­to, Jebres, Surakarta 57126, Central Java. Email: mahandarurafi@gmail.com. Indonesian Journal of Medicine (2021), 06(02): 194-205 https://doi.org/10.26911/theijmed.2021.06.02.08

Use of Cerebral Oximetry in Elective Cesarean Section Procedures Performed Under Spinal Anesthesia: A Randomized Prospective Study

Use of Cerebral Oximetry in Elective Cesarean Section Procedures Performed Under Spinal Anesthesia: A Randomized Prospective Study

Spinal Anesthesia in Patient with Congestive Heart Failure due to Congenital Atrial Septal Defect, and Pulmonary Hypertension Undergoing Cesarean Section Procedure: A Case Report

Introduction. In patients suffering from heart disease, pregnancy is a risk factor for mortality. Heart disease in pregnant women can be in form of rheumatic heart disease, cardiomyopathy, or congenital heart disease. This case report is about the successful spinal anesthesia technique in cesarean section (C-section) patients with congestive heart failure due to congenital atrial septal defect, and pulmonary hypertension (PH).&#x0D; Case presentation. A pregnant woman, 24 years old, planned to have an emergency C-section. She complained about shortness of breath for 2 days before admission. Three months ago, the patient started to feel shortness of breath during activity and also complained her legs swelled. She has a history of congenital heart i.e. atrial septal defect (ASD), but not routinely been treated. Her examination showed tachypnea, murmur, bibasilar fine crackles lung sound, and pretibial pitting edema. Echocardiography showed ASD with pulmonary hypertension. Spinal Anesthesia using 0.5% isobaric bupivacaine 7.5 mg and fentanyl 25 µcg was given before surgery. Drugs was injected in L3-L4 level with the upper target was as high as T6. the head position is raised 30 degrees. Procedure went well and the APGAR score was 8/9, Patient was admitted to the ICU for one day and discharged from hospital at the 5 days of hospital care.&#x0D; Conclusion. Spinal single-shot spinal anesthesia with small doses of bupivacaine and adjuvant can be used as an alternative technique in emergency C-section for patients with congestive heart failure due to congenital atrial septal defect, and pulmonary hypertension.

Региональный регистр кесаревых сечений «КесРегистр» – опыт цифровизации оперативного акушерства на примере Свердловской области

Introduction. Caesarean section is one of the most common surgical procedures in the world and its frequency continues to increase, especially in developing and developed countries. While caesarean section can save lives, it is often performed without medical indications, putting women and their children at risk of high morbidity in the short or long term. Aim. To create a single digital regional database of all caesarean section procedures. To automatize the analysis of medical organizations in online format. To conduct a continuous online monitoring of surgical interventions in obstetrics. Materials and methods. It was decided to develop and introduce the regional register of cesarean sections «CesRegister» in the Sverdlovsk region as a structural and functional module of the automated information system «Regional Obstetric Monitoring» (AIST «RAM»). The goal of the system is to improve the quality of medical care for pregnant women and improve the systems for supporting medical decision-making in the operational obstetrics as well as to automatize the analytics of obstetric care institutions activities, including the Robson classification. Results. AIST «RAM» allowed to collect the data on caesarian sections performed from the electronic medical records. This information, collected before the introduction of the register, provided the possibility of automated analytics and implementation of the systems for supporting medical decision-making in the operational obstetrics. Conclusions. «CesRegister» can help to reduce the percentage of repeated cesarean sections by providing information about previous births online and enabling doctors to quickly make the right and safe decision on the management of pregnancy and childbirth.

Beyond Literal Understanding: “Womb Theft” as Metonym – An Interpretation of the Language Used to Describe Caesarean Kidnappings

The author’s attention has, in recent years, been drawn to an article with the headline, “Womb theft accused testifies”, and to another titled “Sentence reduced for attempted womb theft”. Both articles referred to “womb theft” as the appropriation of a fetus from an expectant woman by a female perpetrator who fakes a pregnancy, and then brutally kills the pregnant woman in order to appropriate the unborn child to keep as her own. Such criminals literally slash open an expectant woman’s womb to reach for the fetus in what can be described as a bizarre replication of a Caesarean section procedure. The author was not entirely clear on what writers meant by “womb theft”, which, defined literally, indicates that the object of theft is the womb/uterus and not a fetus/newborn. If a womb in its literal sense qualifies to be an object of theft, a writer could surely foresee the confusion that would follow headlines such as “Sentence reduced for attempted womb theft” or “Womb theft accused testifies.” The failure to do so exposes a conceptual skew in the discursive construction of the nature of the crime. There has been little research into problems in the language used to describe Caesarean kidnappings from the standpoint of those interested in improving legal language construction. Perhaps a special category of figurative language is required to explain how “womb theft” is used and understood here. The author pursues this task through metonymic analysis, a method that has found little application in legal theory in the South African context. The author argues that figurative expressions are repeatedly used without critical reflection, thereby confusing the recipient and obscuring communication rather than enlightening it. The author does not argue that the use of metonym in legal contexts should be eradicated since, in some instances, they enhance the understanding of legal concepts; instead, legal scholars must see through figurative language, and develop critical dialogue on the stylistic use of metonym and in so doing, master the art of legal communication.

Breast feeding after caesarean delivery on maternal request: protocol of a systematic review and meta-analysis

IntroductionCaesarean delivery under maternal request (CDMR) is a major factor contributing to the rising global rates of caesarean section (CS) procedure. The choice of CDMR without medical indications could provide...

Morbid Adherent Placenta among Pregnant Women prior to Cesarean Delivery: Experience of 15 Cases at a Tertiary care Hospital in Bangladesh

Background: Morbid adherent placenta among pregnant women is a very serious condition.&#x0D; Objective: The purpose of the present study was to identify the risk factors predisposing to morbidly adherent placenta, different modes of management and maternal and neonatal outcomes.&#x0D; Methodology: This cohort study was conducted in the Department of Obstetrics and Gynaecology in Enam Medical College, Dhaka, Bangladesh from January to December 2018 for a period of one (01) year. The study included all pregnant women, irrespective of parity status, with gestational age more than 29 weeks who had any type of morbid adherent placenta. The diagnosis was made only during attempted manual removal when the plane of cleavage between the placenta and the uterine wall could not be made out. The complete history, physical examination of the patient along with relevant investigations for diagnosis of morbid adherent placenta were documented. The mood of the presentation of the patient and duration of gestation, history of previous lower segment or classical caesarean section or other intrauterine operative procedure, by lateral uterine ligation, internal iliac artery ligation, hysterectomy-classical or lower segment or peri-partum, neonatal outcome and duration of the hospital stay all were recorded.&#x0D; Result: The incidence of morbidly adherent placenta was 12.75 per 1000 pregnancies. Patient profile comprising third gravida in the age group of 25 to 28 years, 92 % of the patient in this study have previous caesarean section and co-existing placenta praevia was diagnosed in 93%. 47% of the women delivered between 36 &amp; 38 weeks. Caesarean section was the mode of delivery in 93% of the patient.&#x0D; Conclusion: In conclusion young adult women with previous caesarean section with co-existenting of placenta praevia are the most commonly suffering from morbidly adherent placenta&#x0D; Journal of National Institute of Neurosciences Bangladesh, 2020;6(1): 33-37

The Perioperative Services Response at a Major Children's Hospital During the Peak of the COVID-19 Pandemic in New York City.

The Perioperative Services Response at a Major Children's Hospital During the Peak of the COVID-19 Pandemic in New York City.

The Association Of Race With Outcomes Among Parturients Undergoing Cesarean Section With Perioperative Epidural Catheter Placement: A Nationwide Analysis.

Background: In obstetrical health care, disparities have been documented in different aspects of maternal care and outcomes. Prior epidemiological studies have shown that labor analgesia is underused in African-American and Hispanic groups, which means there may be inadequate labor pain control in these groups. Differences in usage have been attributed primarily to insurance, educational levels and perceptional influences such as fear of paralysis and chronic low back pain. In cesarean section deliveries, race and ethnicity affect the choice of anesthesia considered. How race and ethnicity affect maternal outcomes in cesarean sections with epidural placements generally has been unexplored. Disparities in health care utilization are shown to contribute to the disparities in health outcomes.Methods: This is a retrospective analysis using data from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project (AHRQ-HCUP), the National Inpatient Sample (NIS) database from January 2003 to December 2013, which is a 20% stratified sample of the nonfederal hospitals in the United States. Women undergoing cesarean section (International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure codes 74.0, 74.1, 74.2, 74.4, 74.99) with perioperative epidural catheter placement (ICD-9-CM procedure codes 3.90, 3.91) were included for analysis.Results: The final cohort used for analysis included 87,076 patients. There were significant differences in the distribution of patient characteristics across the race groups. The majority of health care coverage for Caucasians and Asians was private insurance, while for African-American, Hispanic and Native American was Medicare and Medicaid. Almost all the examined comorbid conditions were statistically significant and highest in the African-American group, including hypertension, obesity, diabetes, and renal failure, except for congestive heart failure that was highest in the Asian group. Cesarean sections took place mostly in an urban teaching hospital across all groups. Discharge to home was the predominant destination after recovery. The mean cost of hospitalization was 14,604 dollars per stay and the mean length of stay was 3.7 days. In our cohort, the adverse event rate was very small. Our findings indicate racial differences in comorbidities which occurred more often in minorities. Adverse maternal outcomes of hematoma, blood transfusion, cardiac arrest, and ventricular fibrillation occurred more frequently in minority groups undergoing cesarean sections with epidural catheter placements throughout the period of 2003-2013.Conclusion: From using the NIS database, our findings indicate racial differences in comorbidities which occurred more often in minorities. Adverse maternal outcomes of hematoma, blood transfusion, cardiac arrest, and ventricular fibrillation occurred more frequently in minority groups undergoing cesarean sections with epidural catheter placements throughout the period of 2003-2013. Further population studies are warranted to determine the biological or perception etiologies that are contributing to these disparities.

Caesarean section in Benin and Mali: increased recourse to technology due to suffering and under-resourced facilities.

In line with policies to combat maternal mortality, the medicalization of childbirth is increasing in low-income countries, while access to healthcare services remains difficult for many women. High caesarean section rates have been documented recently in hospitals in Mali and Benin, illustrating an a-priori paradoxical situation, compared with low caesarean section rates in the population. Through a qualitative approach, this article aims to describe the practice of caesarean section in maternity wards in Bamako and Cotonou. Workshops with obstetricians and midwives; participant observation inside labour rooms; and in-depth interviews with caregivers, patients and policy makers have indicated increased recourse to caesarean section due to women’s and caregivers’ suffering and under-resourced facilities. Within these procedures, two types of caesarean section were documented: ‘maternal distress caesarean section’ and ‘preventive caesarean section’. The main reasons for these caesarean sections are maternal fear and pain, and a lack of resources. Inadequately resourced facilities lead to staff suffering and ethical breakdowns, and encourage the inappropriate use of technology. The policy of access to free caesarean section procedures exacerbates the issue of non-medically-justified caesarean sections in these countries. The overuse of caesarean section is particularly alarming in countries with high fertility as it constitutes a danger to both mothers and babies in the short and long term. Currently, conditions are in place in Benin and Mali for an increase in non-medically-justified caesarean sections. In the short term, such an increase could constitute a new burden for these two sub-Saharan countries, where maternal mortality is high.