Cases Of Cesarean Section Research Articles

Vaginal Delivery under Epidural Analgesia in Pregnant Women with a Diagnosis of Moyamoya Disease

Moyamoya disease more commonly occurs in young people and women, so patients with this disease may experience pregnancy and delivery. Cesarean section (CS) is often chosen as the mode of delivery for these patients in Japan. No appropriate mode of delivery has yet been established for pregnant women with moyamoya disease in terms of stroke prevention. We have used vaginal delivery under epidural analgesia (EA) in such patients unless CS has been indicated for the maternal or fetal reasons. This study retrospectively analyzed our patients with moyamoya disease who gave birth to confirm the safety of vaginal delivery under EA. Twelve consecutive patients diagnosed with moyamoya disease had 14 deliveries at our hospital between September 2004 and January 2013. The incidences of intrapartum stroke were compared between cases of vaginal delivery under EA and CS cases. Ten vaginal deliveries under EA and 4 elective CSs were performed. No intrapartum stroke was observed during either vaginal delivery under EA or CS. Among the patients who underwent vaginal delivery under EA, 1 parturient who experienced 2 deliveries suffered transient ischemic attack during both postpartum periods. All 14 infants were healthy without sequelae. Vaginal delivery under EA is an option for patients with moyamoya disease, provided that close cooperation with neurosurgeons, obstetricians, and anesthesiologists is assured.

Analysis of Etiology, Diagnosis and Treatment of Neonatal Pathological Jaundice

<strong>Objectives: </strong>To investigate the causes of neonatal pathological jaundice and provide the basis for clinical diagnosis and treatment. <strong>Method: </strong>The clinical data of 120 cases of neonatal jaundice were analyzed retrospectively. <strong>Results: </strong>In the cause of the disease, 22 cases of neonatal asphyxia, accounting for 21, 17.50% cases of breast feeding, accounting for 13, 10.83% cases of ABO hemolytic disease, accounting for 24.17%, 8 cases of cesarean section, accounting for 6.67%, 5 cases of premature delivery, accounting for 4.17%, 6 cases of intracranial hematoma, accounting for 5%. Infection, breast feeding, neonatal asphyxia, ABO blood group incompatibility is an independent factor. 120 cases were cured and discharged. No serious sequelae and dysfunction occurred. <strong>Conclusion: </strong>To strengthen the perinatal health care, and pay attention to the prevention and treatment of risk factors, such as infection, neonatal asphyxia, and the use of appropriate breast feeding, can effectively reduce the incidence of neonatal pathological jaundice.

Evaluation of risk factor and complication of umbilical cord prolapsed in cesarean section

Objectives: Considering the rarity of umbilical cord prolapse (UCP) and lack of accurate data about the risk factors and health outcomes, we aimed to evaluate cases of cesarean section (CS) due to UCP in order to reduce treatment costs and provide information about the mortality and morbidity associated with this condition.Patients & Methods: Of 35,259 cases of CS performed in four hospitals during 2004-2012, 103 cases of UCP were selected as the case group; on the other hand, 318 cases without UCP were classified as the control group. Information was extracted from patients' records and analyzed by SPSS version 18. Results: Prevalence of UCP was estimated at 0.2%. In the case group, the active phase of labor was reported 1.4 times (81% vs 57%-P<0.00), engagement 8 times (14% vs 2% -P<0.001), transverse presentation 8 times (6% vs 2%-P<0.002), grand multiparity 3.9 times (4% vs 0-P<0.001), oligohydramnios 4.7 times (5% vs. 0-P<0.0001, and polyhydramnios 5.9 times (6% vs 0 - P<0.001). UCP was more prevalent in post-term deliveries (P<0.043). One-minute Apgar score < 7 was 3 times more prevalent in neonates of the case group (P<0.00). Prepartum vaginal bleeding was 4 times more common in the case group, compared to the control group; also, decreased fetal movement and heart rate drop were more prevalent in the case group. Mortality rate was 5.2% in the case group and 1.7% in the control group. Overall, the control group had a better general health at discharge, compared to the case group. Conclusion: A statistically significant correlation was detected between UCP and gestational age, active phase of labor, fetal presentation, engagement, parity, and amniotic fluid volume.

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Objectives Patients with hypertensive pregnancies are regarded to be susceptible for placental abruption (PA). Emergency cesarean section is preferred when the fetus is alive, but the mode of delivery after intrauterine fetal death (IUFD) is still controversial. We experienced a case of a patient with a hypertensive pregnancy that had a vaginal birth after IUFD by PA; she had cesarean section after recurrent PA 2 years later. We compared a trial of vaginal birth for IUFD fetus by PA (2011 onward) with immediate cesarean section (historical controls, performed before 2010). Methods Nine cases of vaginal birth trial after IUFD by PA were compared with eleven cases of immediate cesarean section as a historical case control study from review of medical records. Maternal age, gestational age, parity, course of delivery including time to deliver, blood loss or blood transfusion were compared statistically. Results One patient with a hypertensive pregnancy (superimposed preeclampsia) and IUFD after PA completed vaginal birth with little complications; she encountered recurrent PA 2 years later. In the second pregnancy, the fetus was survived so immediate cesarean section under general anesthesia was performed resulting in a liveborn baby. Eight of 9 trials of vaginal birth were completed successfully after IUFD by PA; however, one case failed to progress and cesarean section was needed. Maternal age, parity, blood loss or amount of blood transfusion showed no significant difference between two groups. The duration of hospital stay was significantly shorter in vaginal birth group compared to cesarean section group (P Conclusions Vaginal birth after IUFD by PA showed no inferiority against immediate cesarean section. However, one case of hypertensive pregnancy had recurrent PA. Strict reproductive and psychological follow-up is also required for patients who experience IUFD. Disclosures K. Nakano: None. K. Iwai: None. Y. Yamada: None. J. Akasaka: None. A. Shigemitsu: None. S. Onishi: None. K. Naruse: None. H. Kobayashi: None.

Anaesthesiologist's role in the multidisciplinary approach to placenta percreta.

Abnormal placentation, an obstetrician's nightmare[1] presents a challenge. We present a case of caesarean section, in a patient with placenta percreta managed by multidisciplinary approach and the challenges faced by anaesthesiologist during the management. The challenges include preparation for massive blood loss, managing anaesthesia in a pregnant patient in a remote location, and transport of an anaesthetised patient back and forth between interventional radiology suite and the operation theatre.

A comparative study of Intrathecal clonidine and fentanyl along with bupivacaine in spinal anesthesia for caesarean section

Background: Patients undergoing caesarean section under spinal anaesthesia often experience pain in the perioperative period. The aim of this study was to evaluate the effect of intrathecal combination of clonidine and bupivacaine compared with bupivacaine and opioid on the incidence and severity of pain in elective caesarean section cases. Materials and Methods: Ninety healthy parturient at term scheduled for elective caesarean delivery were randomly allocated to receive intrathecally hyperbaric bupivacaine alone (Group B) or combined with 75 μg of clonidine (Group C) or with fentanyl 25 μg (Group F). The peak sensory block level, time to reach peak block level from injection, time to two segment regression, maximum degree of motor block, side effects, perioperative analgesic requirements and time to the first analgesic request after surgery were recorded and statistically analysed. Results: Time to two segment regression was significantly prolonged in Group C (78.87 ± 13.362 mins.) and Group F (84.17 ± 12.463 mins.) as compared to Group B (69.70 ± 14.005 min); (P < 0.05). There was significant prolongation of postoperative analgesia as seen by the time to first analgesic request after surgery in Group C (3.550 ± 1.1013 hours) and Group F (5.183 ± 1.1706 hours) as compared to Group B (2.350 ± 0.9016 hours). (P < 0.05). There was increased incidence of hypotension and nausea in Group C compared to other two groups. Conclusion: Perioperative analgesia was prolonged by the addition of 75 μg of clonidine and 25 μg fentanyl to bupivacaine, with increased side effects of nausea, vomiting and hypotension in the clonidine group.

A Pilot Study of 2-Octyl Cyanoacrylate (Dermabond™) versus Conventional Suture Skin Closures for Caesarean Sections

Introduction: 2-octyl cyanoacrylate (Dermabond™, Ethicon, USA) has been available as an alternative skin closure since 1997. There are no reports on keloid formation with 2-octyl cyanoacrylate (2OC) closure for Caesarean section. Our study aims to assess keloid formation after Caesarean sections, as well as the safety and efficacy of 2OC for skin closure in Caesarean sections. Methods: A pilot study of 97 cases of Caesarean section performed by a single surgeon was done — 50 2OC closure versus 47 suture closure. Keloid formation, average operating time, wound infection, wound dehiscence and adverse peri-wound conditions were compared. Proportions across the two series were compared using chi-square/fisher exact test. Average operating time was compared using unpaired t-test. Results: Keloid formation was not statistically significant (2OC 24.0% versus S 14.9%, p=0.382). Mean operating time was similar (2OC 34.1±7.2 minutes versus S 32.7±7.2 minutes, p=0.33). Wound infection rate was similar (2OC 2.0% versus S 2.1%, p=0.939). More women experienced adverse peri-wound conditions with suture closure (2OC 2.0% versus S 6.4%, p=0.303). No woman experienced wound dehiscence. Conclusion: 2-octyl cyanoacrylate has similar efficacy to suture skin closure in terms of keloid formation, operating time, wound infection and adverse peri-wound conditions. It can be a safe alternative for Caesarean section skin closure.

Vaginal cesarean section: heir to, but not legacy of Dührssen's incision.

Vaginal cesarean section is a uterine incision technique derived from Dührssen's incision, with which it is sometimes confused. We report here our experience over 10 years with this technique, with the aim of defining the situations in which it is potentially useful. We retrospectively analyzed 24 cases of vaginal cesarean section (i.e. cervico-segmental incision) carried out from 2002 to 2011 in our tertiary maternity unit. This corresponds to an incidence of 1.1 per thousand deliveries. The main outcome measures were the indications and complications of vaginal cesarean section. The study population included 42% nulliparous women. The fetuses concerned had a median gestational age of 24 weeks + 5 days (18 to 34 weeks + 1 day) and a median weight of 595 g (340-1,250 g). The indications for vaginal cesarean section were severe maternal morbidity in 54.2% of cases, failed labor induction in 29.2% and another indication in 16.7%. All but one of the fetuses were dead or nonviable. Surgical complications were observed in three cases: two difficulties achieving hemostatic control and one bladder injury. Vaginal cesarean section is sometimes considered obsolete, but it has several advantages: technical simplicity, limited tissue dissection, low risk of hemorrhage and no abdominal scar. These features make it particularly suitable for the extraction of medium-sized dead or nonviable fetuses when pharmacological options are ineffective or not rapid enough in cases of poor maternal condition.

Laser acupuncture effect on fetal well-being during induction of labor.

Labor induction with traditional drugs is sometimes associated with fetal complications as fetal distress or death. The aim of this study was to evaluate the effect of labor induction by laser acupuncture on fetal well-being in post-term pregnancy. Nulliparous women at 40 weeks or greater were randomized to sham laser group versus laser acupuncture group. Each session consisted of laser application on bilateral points LI 4, SP 6, BL 31, and BL 32. The study was conducted in Cairo University, National Institute of Laser Enhanced Sciences. Sixty nulliparous women were randomized into laser acupuncture group n = 30 and control group n = 30. Women were treated in both groups in three consecutive days in post-date pregnancy. Results (66.6%) showed a significant difference in rate of normal vaginal delivery (NVD) between acupuncture group (50%) and control group (50%) (p = 0.002). There was no significant difference of enrollment delivery time between laser acupuncture and sham groups (p > 0.05). There were six cases of cesarean section (CS) due to no fetal movement with normal cardiotocography (CTG). Laser acupuncture has no effect on fetus, and its effect on fetal movement needs more investigations. Laser can induce labor if the cervical length is less than 1 cm and dilation (0).

English

OBJECTIVE: The aim of the study was to see the fetomaternal outcome of pregnancy with previous cesarean section. METHODS: This study was conducted in the department of OBGYN, BARC Hospital, Mumbai from October 2011 to September 2012, a period of one year. All the pregnant women with previous one cesarean section attending ANC clinic for confinement were included in the study group after giving consent. RESULTS: Out of total75 cases, a total of 23 patients (30.67%) were given trial of labor. Out of 23 patients given trial of labor, 12 patients (52.17%) had successful VBAC. Commonest indication for unsuccessful trial of labor undergoing repeat cesarean section was nonprogress of labor (54.55%) and failed IOL (36.67%). Out of 12 patients who had successful VBAC, 3 patients (25%) had complication like episiotomy hematoma, perineal tear and cervical tear. No patients had major complications. In present study no baby had apgar score <7 at 1min and 5 min in VBAC group and elective LSCS group. CONCLUSION: The current study concludes that women with a prior cesarean are at increased risk for repeat cesarean section. Vigilance with respect to indication at primary cesarean delivery, proper counseling for trial of labor and proper antepartum and intrapartum monitoring of patients, are key to reducing the cesarean section rates. The antepartum, intrapartum and postpartum complications are more in repeat cesarean section cases. There is no doubt that a trial of labor is a relatively safe procedure, but it is not risk free. Therefore, patient evaluation prior to TOLAC, careful observation throughout labor in a well-equipped unit with around the clock services for emergency surgery and availability of expertise is the backbone for successful VBAC.

Court-authorised caesarean section.

Competent adults have the right to make their own decisions regarding treatment. A competent adult has the ability to understand the relevant information, retain it, weigh it up and communicate the decision. Every adult is presumed to be competent, but this presumption can be rebutted. An adult may lack capacity as a result of neurodevelopmental handicap, mental illness or unconsciousness. In these cases, it is clear that the health professional has to act in the patient's ‘best interests’. The difficulty arises in other cases in which capacity is temporarily absent because of confusion, fatigue, pain, drugs or panic induced by fear. The issue here is that, although a decision made by a competent adult does not have to be rational, irrationality could indicate incompetence. Further, doctors and lawyers could hasten to declare a patient incompetent if any of the aforesaid factors is present. Doctors’ concern for fetal wellbeing may conflict with a woman's right to self-determination. These issues are illustrated by USA and UK caesarean section (CS) cases. In the US case Doe v Doe 1994, the Illinois Appellate Court upheld the right of a woman who declined CS on religious grounds. The court discountenanced the argument that concern for fetal wellbeing should override the woman's right. Prior to this case, however, there had been cases of court-authorised caesarean delivery for fetal indication – such as Jefferson v Griffin Spalding County Hospital Authority 1981. Both the American College of Obstetricians and Gynecologists and the American Medical Association state that the woman has the final decision on CS. Nevertheless, a Florida court took a contrary view in Pemberton v Tallahassee Memorial Regional Medical Center 1999 – a case of previous classical CS. The position of the UK courts has evolved. In Re S (adult: refusal of treatment) 1992, the mother declined CS for religious reasons. At a lunchtime hearing, the court authorised delivery. This sparked an animated debate among legal and social commentators. Nevertheless, CS was imposed on non-consenting women in further cases: Norfolk and Norwich Healthcare NHS Trust v W 1997; Tameside and Glossop Acute Services Trust v CH 1996. In the latter, it was held that CS on a schizophrenic woman could be regarded as ‘treatment’ under the Mental Health Act 1983. The issue was revisited in Re MB (an adult: medical treatment) 1997. The Court of Appeal affirmed the unqualified right of a competent woman to decide whether or not to accept CS, regardless of the risk to her baby or herself. It declared, however, that this woman was incompetent because of a fear of needles (her reason for refusing the operation). In St George's Healthcare NHS Trust v S 1998, the woman was detained under s.2 of the Mental Health Act and CS was performed under a court order, but she appealed against this decision. Her appeal was upheld and the use of mental health legislation to enforce obstetric treatment was deplored. The court reaffirmed the position that a competent pregnant woman has the right to refuse medical intervention. The author declares there are no conflicts of interests.

Effect of low-risk pregnant women before labor admitted to hospital on cesarean section rate and countermeasures

Objective To understand the psychological state , labor and childbirth knowledge awareness in hospitalized pregnant women with 37 to 41 weeks gestation and effect on rate of cesarean section , and to put forward the corresponding countermeasures .Methods Two hundred hospitalized pregnant women were chosen and divided into the labor group in which the pregnant women felt contractions regularly and the cervical dilatation was more than 1 cm and the no labor group in which the pregnant women were threatened labor or without, each with 100 cases.The self-rating anxiety scale （SAS）, the self-rating depression scale （SDS）, and the questionnaire on the knowledge of labor and delivery were used in two groups , and the delivery outcome was investigated.Results The scores of SAS and SDS were respectively （49.21 ±6.09）, （58.97 ±6.43） in the no labor group, and were higher than （42.96 ±5.61）, （49.95 ±6.02） in the labor group, and the differences were statistically significant （t=3.074, 4.146, respectively;P〈0.01）.The incidence rates of anxiety and depression in the no labor group were higher than those in the labor group , and the differences were statistically significant （χ2 =7.14, 5.64, respectively;P〈0.05）.The qualification rate of mastering the knowledge of labor and delivery was 63.0%in the labor group, and was 27.0%in the no labor group, and the difference was statistically significant （χ2 =26.18, P〈0.01）.The cases of cesarean section were 65 in the no labor group including 44 cases cesarean section induced by social factors , and were 19 in the labor group including 8 cases cesarean section induced by social factors , and the difference was found in the rate of cesarean section in two groups （χ2 =43.44, P 〈0.01 ）.Two groups of pregnant women in labor oxytocin utilization comparative difference was statistically significant （P〈0.01）.Conclusions The main causes of early admission in the without labor pregnant women are respectively the psychological state before labor and the awareness of the knowledge of labor and delivery .The situation of the psychological state before labor and the awareness of the knowledge of labor and delivery in the no labor group are worse than that in the labor group , and the psychological health during pregnancy should be strengthened , and the propaganda and education of the knowledge of labor and delivery should be increased . Key words: Pregnant woman; Cesarean section; Labor; Psychological state

Analysis of perinatal nutrition clinic intervention on pregnancy outcomes of patients with gestational diabetes mellitus

Objective To explore the efficacy of perinatal nutrition clinic intervention on pregnancy outcomes of patients with gestational diabetes mellitus (GDM).Methods 440 pregnant women who had been diagnosed with gestation diabetes mellitus (GDM) in prenatal examinations received the medical service in our hospital from March 2012 to September 2013.They were divided into two groups according to nutrition clinic history,200 cases in intervention group and 240 cases in control group.Results The blood glucose level A of intervention group was significantly lower than that of control group (P ＜ 0.01).There were 67 cases of cesarean section in intervention group (33.5％),121 cases in control group (50.4％),with significant difference (x2 =12.757,P ＜ 0.01).The incidence of macrosomia in intervention group was 2.5％ (5/200),while that in control group was 7.1％ (17/240),with significant difference (x2 =4.852,P ＜ 0.05).The incidence of neonatal hypoglycemia in intervention group was 3.0％ (6/200),while that in control group was 7.9％ (19/240),with significant difference (x2 =4.921,P ＜ 0.05).Conclusion Scientific dietary guidance for GDM pregnant women provided by perinatal nutrition clinic can effectively control their blood glucose and improve perinatal outcomes of GDM mothers and their infants. Key words: Gestational diabetes; Nutrition clinic; Pregnancy outcome

English

Generalized peritonitis following lower segment caesarean section with uterine incision necrosis and dehiscence presenting as genitourinary fistula is very unusual. Herein we report a case of 28 years old woman who was received in emergency hours as a referred case from a private nursing home with history of caesarean section done 11 days back for premature rupture of membranes and pregnancy induced hypertension. She came with complaints of continuous watery discharge per vaginum, high grade fever with chills and rigor, nausea, vomiting, breathlessness, severe diffuse abdominal pain and distension of abdomen since last 4-5 days. Here acute abdomen series was done. The urologist ruled out genitourinary fistula. CECT of abdomen was done. She was diagnosed to be a case of generalized peritonitis following caesarean section with necrosis and dehiscence of suture line of uterus through which ascitic fluid was being drained into vagina. Consequently, patient underwent laparotomy. Gentle adhesiolysis with supra cervical hysterectomy was done. Thorough drainage and irrigation of pelvi-abdominal cavity was done. Post-operative period was uneventful. INTRODUCTION: It is unusual for peritonitis to develop following caesarean delivery. It is almost invariably preceded by metritis and uterine incisional necrosis and dehiscence. Other cases may be due to inadvertent bowel injury at caesarean delivery. Yet another cause is peritonitis following rupture of a parametrial or adnexal abscess.1 Herein we report a case of 28 years old woman who was received in emergency hours as a case of post-operative caesarean section which was done in a private nursing home 11 days back. She presented with complaints of continuous watery discharge per vaginum, high grade fever with chills and rigor, nausea, vomiting, breathlessness, severe diffuse abdominal pain and distension of abdomen since last 6-7 days. The first clinical impression that she gave was that of a genitourinary fistula following caesarean section. After complete work up, her provisional diagnosis was to be a case of generalized peritonitis following post caesarean uterine wound necrosis with dehiscence and the ascitic fluid was being drained through this uterine rent. Emergency laparotomy was done. Gentle adhesiolysis with supracervical hysterectomy was done. Post-operative period was uneventful.

ASSOCIATION OF APGAR SCORE WITH DELIVERY MODE IN THE NON DISTRESS NEWBORNS

The Apgar score is the most commonly used measure of newborn infant well-being. Infants of women with caesarean section were at increased risk of low Apg ar score and/or perinatal death. The aim of study w as to determine the impact of the cesarean section on Apg are score. This is a case-control study, which comp ared 100 Elective Cesarean Section (ECS) cases, with 199 uncomplicated Normal Vaginal Deliveries (NVD). All newborns were product of first or second pregnancy and they are full term and singleton babies. Apgar score in the minute 5 was measured in both groups. The descriptive and analytical statistics (X 2 and T test) were used. Average of fifth Apgarscore was 8.63±0.79 in NVD group and was 8.79±0.94 in ECS group, that there was no significant difference. About 76. 5% of the NVD neonates in minute 5 had Apgar scores of 9 and 10. While in cesarean group, 59% of the neona tes in minute 5 had Apgar scores of 9 and 10. There was no significant difference between minute five A pgar scores of the two groups. Therefore it is not acceptable that with ECS baby will have worse Apgar score.

Effect of gestational diabetes mellitus on perinatal outcome

Objective To investigate the women during pregnancy because of various reason caused by the impact of diabetes on perinatal outcome.Methods The delivery 24-28 weeks pregnant or first diagnosed more than 28 weeks after the gynecology clinic diagnosis with diabetes in 125 singleton pregnant women and newborns were selected as the research object of study.Except giving birth to the same period 95 cases of normal of diabetes single fetus of pregnant women and their newborn for the control group.The complications of pregnancy and gestational age,birth and neonatal intrauterine nutrition status,mode of delivery,neonatal asphyxia,hypoglycemia and jaundice,case analysis,comparison.Results The two groups in the average age,average number of pregnancy pregnancy and intrauterine nutrition(group GDM,PI =2.717,control group 2.469) and the rate of neonatal asphyxia were not statistically significant(P ＞ 0.05).GDM group of 71 cases of cesarean section,natural childbirth in 54 cases,31 cases of control group difference and 64 cases,very significant differences between the two groups (x2 =12.678,P ＜ 0.01),group GDM,the incidence of neonatal jaundice neonatal hypoglycemia respectively 18.4%,24%,and 7.4% in the control group,there was significant difference compared with 12.6% (x2 =4.500,5.577,all P ＜0.05).Conclusion Gestational diabetes is the important reason which caused by adverse perinatal outcome. Key words: Diabetes, gestational; perinatal; Pregnany outcome

Amnion protective cesarean section – method for gentle delivery of preterm and/or VLBW neonates

More than 50 percent of preterm neonates below 28 gestational weeks in our institution are delivered by cesarean section (CS).Aim: To present advantages of less used method of delivery of premature and/or very low birth weight (VLBW) neonates by Amnion Protective Cesarean Section (APCS) when indicated and to review our experience with the method. It can be used in all deliveries by CS with unruptured amniotic membranes, at all gestational ages.Materials and methods: Including criteria were singleton pregnancies, gestation of 26 to 35 weeks and birth body weight between 700 to 1500 g. According to the criteria, during the studied period 10 neonates were delivered by APCS. We compared the outcomes of APCS neonates with ones delivered by coventional CS who matched them in mentioned criteria.Results: Compared to CS cases, APCS neonates had statistically significant better first minute AS. Stay in NICU was shorter for APCS neonates but not statistically significant. From our experience APCS neonates had clinically better appearance (less bruises and hematomas).Conclusion: APCS is promising method for delivery of preterm and/or VLBW neonates when indicated, although prospective studies are needed in order to prove its effectiveness compared to conventional CS.

REFUSAL OF EMERGENCY CAESAREAN SECTION IN IRELAND: A RELATIONAL APPROACH

This article examines the issue of emergency caesarean section refusal. This raises complex legal and ethical issues surrounding autonomy, capacity, and the right to refuse treatment. In Ireland, the situation is complicated further by the constitutional right to life of the unborn. While cases involving caesarean section refusal have occurred in other jurisdictions, a case of this nature has yet to be reported in Ireland. This article examines possible ways in which the interaction of a woman's right to refuse treatment and the right to life of the unborn could be approached in Ireland in the context of caesarean section refusal. The central argument of the article is that the liberal individualistic approach to autonomy evident in the caesarean section cases in England and Wales is difficult to apply in the Irish context, due to the conflicting constitutional rights of the woman and foetus. Thus, alternative visions of autonomy which take the interests and rights of others into account in medical decision-making are examined. In particular, this article focuses on the concept of relational consent, as developed by Alasdair Maclean and examines how such an approach could be applied in the context of caesarean section refusal in Ireland. The article explains why this approach is particularly appropriate and identifies mechanisms through which such a theory of consent could be applied. It is argued that this approach enhances a woman's right to autonomy, while at the same time allows the right to life of the unborn to be defended.

Obstetric factors and pregnancy outcome in placenta previa

Introduction: Placenta previa is one of the major causes for maternal morbidity and mortality. The aim of this study was to analyze the obstetrical factors associated with placenta previa and to find out the maternal and perinatal outcome of these cases. Methods: This was a retrospective study conducted in the Department of Obstetrics and Gynecology of TUTH. Hospital chart records of four years (1st January 2008 to 31st December 2011) were collected. Chart records of all women who had undergone cesarean section for placenta previa were reviewed. Relevant clinical findings were noted. Results: During the study period, there were 82 cases of cesarean sections done for placenta previa, which is 0.55% of the total deliveries. Of the eighty two cases, charts could be obtained of the 70 patients for the analysis. 21.4% had total placenta previa. Maximum women were in age group 26-30 years. Sixty one percent of the patients were multipara. Sixteen patients had history of cesarean section and 20 cases had abortions in previous pregnancy. Malpresentation was present in more than one fifth (21.4%) of the patient. 45.7% of the babies were preterm and 27% were low birth weight babies. Seven babies had neonatal death. Almost one third (31.4%) of the patient had blood loss &ge;500ml. There were four cases with blood loss &ge;1000ml. Among them two had loss of more than two liters. Ten patients required blood transfusion. One patient had cesarean hysterectomy. Conclusion: Placenta previa poses danger to both the mother and the baby. There is high maternal morbidity and adverse perinatal outcome. DOI: http://dx.doi.org/10.3126/joim.v34i2.9053 &nbsp; Journal of Institute of Medicine August, 2012; 34:2 38-41

Obstetric factors and pregnancy outcome in placenta previa

Introduction: Placenta previa is one of the major causes for maternal morbidity and mortality. The aim of this study was to analyze the obstetrical factors associated with placenta previa and to find out the maternal and perinatal outcome of these cases. Methods: This was a retrospective study conducted in the Department of Obstetrics and Gynecology of TUTH. Hospital chart records of four years (1st January 2008 to 31st December 2011) were collected. Chart records of all women who had undergone cesarean section for placenta previa were reviewed. Relevant clinical findings were noted. Results: During the study period, there were 82 cases of cesarean sections done for placenta previa, which is 0.55% of the total deliveries. Of the eighty two cases, charts could be obtained of the 70 patients for the analysis. 21.4% had total placenta previa. Maximum women were in age group 26-30 years. Sixty one percent of the patients were multipara. Sixteen patients had history of cesarean section and 20 cases had abortions in previous pregnancy. Malpresentation was present in more than one fifth (21.4%) of the patient. 45.7% of the babies were preterm and 27% were low birth weight babies. Seven babies had neonatal death. Almost one third (31.4%) of the patient had blood loss ≥500ml. There were four cases with blood loss ≥1000ml. Among them two had loss of more than two liters. Ten patients required blood transfusion. One patient had cesarean hysterectomy. Conclusion: Placenta previa poses danger to both the mother and the baby. There is high maternal morbidity and adverse perinatal outcome. DOI: http://dx.doi.org/10.3126/joim.v34i2.9053 Journal of Institute of Medicine August, 2012; 34:2 38-41