Disproportion Research Articles

Prevalence of Repeat Cesarean Section in a Tertiary Care Hospital.

Cesarean section is the surgical delivery of a baby through an incision made in the mother's abdomen and uterus. Repeat cesarean section has recently increased, partly because of concern about increased risk of uterine rupture in women attempting vaginal birth after cesarean delivery. Among the women who underwent cesarean section in their first delivery, 80-96% had a second surgical delivery. Therefore, the present study aimed to describe the prevalence of repeat cesarean section among Nepali women presented at Kathmandu Medical College and Teaching Hospital who had a previous cesarean section. This was a descriptive cross-sectional study conducted in Kathmandu Medical College and Teaching Hospital from 1st of February to 31st of May 2020. Ethical approval was taken from the Institutional Review Committee of the Kathmandu Medical College. Convenient sampling was done. All pregnant patients between gestational ages of 37-40 weeks with previous cesarean section admitted for safe confinement were included in the study. Among the 104 women, who had prior cesarean section, 99 (95.19%) had second cesarean section and 5 (4.81%) had vaginal birth after cesarean. The most common indication for the first cesarean section was fetal distress 31 (29.81%) while the indication for the second cesarean section among previously cesarean section women was cephalo pelvic disproportion 39 (39.40%). The proportion of cesarean section in both first and subsequent delivery is quite high. This high rate may compromise the reproductive future of the women who underwent consecutive cesarean section with possible consequent complications.

Factors affecting failed trial of labor and countermeasures: A retrospective analysis.

BACKGROUNDVaginal 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.AIMTo 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.METHODSA 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.RESULTSThe 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 during birth, 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%).CONCLUSIONThe 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.

Prevalence, Indications and Complications for Cesarean Sections at District Hospital of Eastern Nepal

Introduction: Cesarean Section (CS) is one of the most common obstetric operative procedures. The procedure of cesarean section is still challenging in hospitals, from rural areas of low-income countries like Nepal, where health resources remain scarce and limited. The aim of this study is to understand the prevalence of cesarean section, clinical indications that prompts CS and maternal complications following CS. Methods: In this descriptive cross-sectional study, all cases of delivery at Ilam District Hospital from Jul 16, 2017 to Jul 15, 2018 were included. Ethical approval was obtained from the institution. Patients attending the hospital were from hilly and remote areas of Ilam, Pachthar and Taplejung districts. The prevalence, clinical indications and outcomes of CS were recorded. Data analysis were conducted using Microsoft Excel. Results: The prevalence of cesarean section was 162(14.70%). The mean maternal age was 24.59 (range 17-39) years. Fetal distress was the leading indication and accounted for 57(35.18%) cases for CS, followed by non-progress of labour 40(24.69%), failed induction 23(14.19%), Cephalopelvic disproportion 17(10.49%) and Breech or malpresentation 11(6.79%). Most of the patients were primigravida 115(70.98%) and mean gestational weeks was 40.21(range 36-44). No major maternal complications were noted. Neonatal mean weight was 3.52(2-5.5) kg and APGAR score of more than 6 at 5th minute were recorded in 158 (97.53%) of newborns. Conclusion: The CS prevalence in our study was within the WHO recommendations of 10-15%. The leading indications for CS were fetal distress and no major complications were seen in mothers or newborns following CS.

Prevalence, Indications, and Community Perceptions of Caesarean Section Delivery in Ngora District, Eastern Uganda: Mixed Method Study.

Background Uganda has a high maternal mortality ratio (MMR) of 336/100,000 live births. Caesarean section is fundamental in achieving equity and equality in emergency obstetric care services. Despite it being a lifesaving intervention, it is associated with risks. There has been a surge in caesarean section rates in some areas, yet others remain underserved. Studies have shown that rates exceeding 15% do not improve maternal and neonatal morbidity and mortality. Our study aimed at determining the prevalence, indications, and community perceptions of caesarean section delivery in Eastern Uganda. Methods and Materials It was both health facility and commuity based cross-sectional descriptive study in Ngora district, Eastern Uganda. Mixed methods of data collection were employed in which quantitative data were collected by retrospectively reviewing all charts of all the mothers that had delivered at the two comprehensive emergency obstetric care service facilities between April 2018 and March 2019. Qualitative data were collected by focus group discussions till point of saturation. Data were entered into EpiData (version 3.1) and analyzed using SPSS software (version 24). Qualitative data analysis was done by transcribing and translating into English verbatim and then analyzed into themes and subthemes with the help of NVIVO 12. Results Of the total 2573 deliveries, 14% (357/2573) were by CS. The major single indications were obstructed labour 17.9%, fetal distress 15.3%, big baby 11.6%, and cephalopelvic disproportion (CPD) 11%. Although appreciated as lifesaving for young mothers, those with diseases and recurrent intrauterine fetal demise, others considered CS a curse, marriage-breaker, misfortune, money-maker and a sign of incompetent health workers, and being for the lazy women and the rich civil servants. The rise was also attributed to intramuscular injections and contraceptive use. Overall, vaginal delivery was the preferred route. Conclusion Several misconceptions that could hinder access to CS were found which calls for more counseling and male involvement. Although facility based, the rate is higher than the desired 5–15%. It is higher than the projected increase of 36% by 2021. It highlights the need for male involvement during counseling and consent for CS and concerted efforts to demystify community misconceptions about women that undergo CS. These misconceptions may be a hindrance to access to CS.

Cephalopelvic disproportion as primary diagnosis for cesarean section: Role of neonatal birthweight in relation to maternal height at a Hospital in Merida, Mexico.

To analyze the association between newborn and maternal characteristics and the risk for cesarean section (CS) due to cephalopelvic disproportion (CPD) and non-CPD causes compared to vaginal deliveries (VD) in a sample of infants and mothers from Merida, Yucatan, Mexico. The final sample consisted of 3453 single, live, and term infants born between January 2016 and May 2017 at the Maternal-Infant Hospital in Merida and their mothers (aged ≥19 years). The mode of delivery was established as the dependent variables: (a) VD, (b) CS due to CPD, and (c) non-CPD CS. Independent variables were maternal height and weight, the number of previous VD, newborn weight, and neonatal birthweight (BW) index/maternal height index. A multinomial regression model was used to analyze the association between newborn and maternal characteristics and outcome variable. By mode of delivery, 2124 (62%) births corresponded to VD, 1042 (30%) to non-CPDCS, and 287 (8%) to CS due to CPD. Mothers who had CS due to CPD weighed more at the end of their pregnancy and were shorter. Maternal age and weight increased the risk for having CS due to CPD compared to VD and maternal height, and the number of previous VD reduces the risk for experiencing CS due to CPD compared to vaginal births. The relative risk ratio for higher neonatal BW/maternal height index was significant for CS due to CPD and non-CPD CS. According to our results from a public hospital in Merida, Mexico, CPD is a result of the interrelation of maternal and fetal size, rather than an independent result of maternal height or BW.

Assessment of Acute Obstetrical Needs and the Potential Utility of Point-Of-Care Ultrasound in the North East Region of Haiti: A Cross-Sectional Study.

Background:Point-of-care ultrasound (POCUS) implemented through task shifting to nontraditional users has potential as a diagnostic adjuvant to enhance acute obstetrical care in resource-constrained environments with limited access to physician providers.Objective:This study evaluated acute obstetrical needs and the potential role for POCUS programming in the North East region of Haiti.Methods:Data was collected on all women presenting to the obstetrical departments of two Ministry of Public Health and Population (MSPP)-affiliated public hospitals in the North East region of Haiti: Fort Liberté Hospital and Centre Medicosocial de Ouanaminthe. Data was obtained via retrospective review of hospital records from January 1 through March 31, 2016. Trained personnel gathered data on demographics, obstetrical history, diagnoses, clinical care and outcomes using a standardized tool. Diagnoses a priori, defined as those diagnoses whose detection could be assisted with POCUS, included multi-gestations, non-vertex presentation, cephalopelvic disproportion, placental abruption, placenta previa, spontaneous abortions, retained products and ectopic pregnancy.Results:Data were collected from 589 patients during the study period. Median maternal age was 26 years and median gestational age was 38 weeks. The most common reason for seeking care was pelvic pain (85.2%). Sixty-seven (11.5%) women were transferred to other facilities for higher-level care. Among cases not transferred, post-partum hemorrhage, infant mortality and maternal mortality occurred in 2.4%, 3.0% and 0.6% of cases, respectively. There were 69 cases with diagnoses that could have benefited from POCUS use. Between sites, significantly more cases had the potential for improved diagnostics with POCUS at Fort Liberté Hospital (19.8%) than Centre Medicosocial de Ouanaminthe (8.2%) (p < 0.001).Conclusion:Acute obstetrical care is common and POCUS has the potential to impact the care of obstetrical patients in the North East region of Haiti. Future programs evaluating the feasibility of task shifting and the sustainable impacts of acute obstetric POCUS in Haiti will be important.

Rates and Indications of Cesarean Section Using the Robson Classification in a University Hospital in Southern Thailand 2014-2016

Objective: To identify the rates and indications of cesarean section (CS) using the Robson classification during 2014- 2016 in a university hospital in southern Thailand. Material and Methods: A cross-sectional study of women who delivered between January 1, 2014 and December 31, 2016 was conducted. The data were analyzed using the Robson classification. Results: A total of 10,474 births were included in the analysis. The overall CS rate was 55.5%. The trends of CS rates in most Robson classification groups over the 3-year period were static. The CS rates in nulliparous or multiparous women with induction of labor decreased over the 3-year period, while the rate in multiparous women with fetal breech presentation increased. Women with previous cesarean section (Robson group 5) were the largest contributor to the overall CS rate (32.1%), followed by the nulliparous women with a single cephalic pregnancy, ≥37 weeks gestation in spontaneous labor (Robson group 1) (24.5%). Cephalopelvic disproportion and fetal distress were the most common indications for CS in Robson group 1. Conclusion: The CS rates in our study were high in all groups during the 3-year period, with static trends in most groups. The Robson classification is a feasible tool for monitoring CS rates in our setting. Feedback of these findings to healthcare providers and policy makers is advised.

Current situation and outcomes of pregnancy in women with Turner syndrome in Japan

Reports on pregnancy and delivery in women with Turner syndrome (TS) in Japan are limited to case reports, and the current situation remains unclear. Therefore, this study aimed to clarify the current situation of pregnancy and delivery in women with TS in Japan. Our study comprised primary and secondary surveys and we included perinatal centers approved by the Ministry of Health, Labor and Welfare. A total of 24 cases from 19 facilities were reported, and we obtained individual information for 20 cases from 16 facilities. Of these 20 patients, 13 (65%) had become pregnant via oocyte donation. Three of these patients had received oocyte donation in Japan, while the other 10 had received donations in foreign countries. The other seven patients became pregnant with their own oocyte, with spontaneous menarche. Live babies were delivered by 18 patients, while an induced abortion was required at 18 weeks of gestation in one patient and an intrauterine fetal death from an unknown cause was detected at 38 weeks of gestation in another patient. Cesarean section was performed in 14 patients, with the most frequent indication being cephalopelvic disproportion. The rate of implementation of screening for complications related to TS was low, suggesting insufficient cooperation between facilities responsible for TS treatment, infertility and pregnancy and delivery management. To improve pregnancy outcomes in women with TS, improved cooperation between facilities and laws regarding oocyte donation in Japan are needed.

Fetomaternal outcome in elderly primigravida

Elderly primigravida is defined as women thirty five years of age or above who is pregnant for the first time. The advancement in the artificial reproductive technology have played an important part in delaying the pregnancy. Maternal age is no longer only important factor in women wishing for conception. Nevertheless the increased fetomaternal complication and consideration as a high risk leading to early intervention among these age group is of concern.The objective of the study was to find out incidence and to determine fetomaternal outcome in elderly primigravida.The study was cross sectional, conducted in Regional Institute of Medical Sciences, Imphal, Manipur over a period of one and half year. Elderly primigravida admitted at term in hospital were studied for fetomaternal outcome.Of 17890 delivery during the study period, 280 were elderly primigravida giving an incidence of 1.8%. Based on inclusion criteria, 166 were enrolled in study.Maternal compilation seen were, Oligohydraminos 6.02%, Gestational hypertension 3.01%, Breech presentation 6.03%, PROM 4.2%, Placenta Praevia 2.4%, Gestational diabetes mellitus 0.6% and Twin gestation 2.4%.Caesarean rate was 67.5% of which 62.5% was done for cephalopelvic disproportion. 5.3% baby was low birth weight.Although fetomaternal complication in Elderly Primigravida is increased, with adequate antenatal care, early recognition of complication and timely intervention, optimum outcome can be expected. Further conclusion drawn from this study is rate of Caesarean section which is of concern and needs to be further assessed.

Frecuencia e indicaciones del parto por cesárea en un hospital docente de Lima, Perú

Introducción. La cesárea es una operación reservada inicialmente para casos en los que el parto eutócico puede comprometer la vida de la gestante o del producto. Por diversas razones, se ha aceptado a la cesárea como método de parto de elección, aumentando su frecuencia. La OMS estableció un margen de tasa de cesáreas de 15% para las cesáreas primarias, ya que valores mayores no representan una disminución en la morbimortalidad fetal. Mundialmente se ha evidenciado tasas de hasta 21% (países europeos) y, en el Perú, 36% en el año 2015. Objetivos. Determinar la frecuencia e indicaciones más frecuentes de cesáreas en un hospital público docente de Lima. Métodos. Estudio descriptivo, tipo serie de casos, de pacientes sometidas a cesárea y sus indicaciones. Se incluyó a pacientes sometidas a cesáreas, electivas o de emergencia, desde enero 2013 hasta diciembre 2017. Resultados. La cesárea fue realizada con una frecuencia de 50,2%, siendo las indicaciones más frecuentes una cesárea previa y la desproporción cefalopélvica. Conclusiones. El estudio halló que se superó la tasa de cesáreas recomendada por la OMS. La indicación más frecuente en el período estudiado fue la cesárea previa.

Bilateral anophthalmia and intrahepatic biliary atresia, two unusual components of Fraser syndrome: a case report

BackgroundFraser syndrome or “cryptophthalmos syndrome” is a rare autosomal recessive disease. It is characterized by a group of congenital malformations such as: crytophthalmos, syndactyly, abnormal genitalia, and malformations of the nose, ears, and larynx. Although cryptophthalmos is considered as a main feature of Fraser syndrome, its absence does not exclude the diagnosis. Clinical diagnosis can be made by Thomas Criteria. Here we present the first documented case of Fraser Syndrome in Aleppo, Syria that is characterized by bilateral anophthalmia and intrahepatic biliary atresia.Case presentationDuring pregnancy, several ultrasound scans revealed hyperechoic lungs, ascites, and unremarkable right kidney at the 19th-week visit; bilateral syndactyly on both hands and feet at the 32nd-week visit. On the 39th week of gestation, the stillborn was delivered by cesarean section due to cephalopelvic disproportion. Gross examination showed bilateral anophthalmia, bilateral syndactyly on hands and feet, low set ears, and ambiguous genitalia. Microscopic examination of the lung, spleen, liver, ovary, and kidneys revealed abnormalities in these organs.ConclusionThe diagnosis of Fraser syndrome can be made prenatally and postnatally; prenatally by ultrasound at 18 weeks of gestation and postnatally by clinical examination using Thomas criteria. Moreover, intrahepatic biliary atresia was not described previously with Fraser syndrome; this recommends a more detailed pathologic study for Fraser syndrome cases.

A retrospective study regarding the method of delivery of adolescents in a Romanian Hospital.

Adolescent pregnancies are associated with a high number of risks for the newborn and mother. Hence, an increased number of emergency caesarean extractions are performed in this group of patients. The aim of this study was to analyze the pregnancy-related conditions, the way of delivery and the neonatal outcome of all the patients who delivered in the Department of Obstetrics and Gynecology of University Emergency Hospital in Bucharest, a tertiary unit in Romania in a period of 5 years. An observational, retrospective study was performed on a group of 686 patients, aged 12 to 19 years, who delivered in the Department of Obstetrics and Gynecology of University Emergency Hospital in Bucharest, between January 1, 2014 and December 31, 2018. The pregnant women were divided into two age groups. In the first group were pregnant patients aged under 18 years, and in the second group pregnant adolescents between 18 and 19 years. Whether the patients underwent prenatal screening was analyzed. Furthermore, the age of the patients, the rate of caesarean extraction and vaginal birth and the obstetrical complications were evaluated and compared. The outcome of the newborns was assessed based on Apgar score at 1 min and birth weight. Regarding the results, 464 of the 686 patients did not undergo any medical visits during pregnancy. In total, 52.76% of the patients delivered by caesarean section. The most frequent indications for caesarean extraction, in both analyzed groups, were Cephalo-pelvic disproportion, fetal distress and uterine scar after caesarean section. The lack of specific protocols regarding the ante-, peri- and post-natal management of adolescents is probably the cause of the alarmingly increasing number of patients pertaining to the group who deliver by caesarean section.

Drug utilization of antibiotics in post-operative cesarean section inpatients in tertiary care hospital: a prospective observational study

Background: The aim of this study is to evaluate the pattern and rational use of antibiotics in post-operative caesarean section (CS) inpatients in tertiary care teaching hospital, BIMS Belagavi.Methods: This cross sectional prospective observational study was conducted from December 2019 to February 2020, prior permission from institutional ethics committee was taken. Detailed data of post-operative caesarean section (CS) inpatients including age, diagnosis, line of management, complications and any adverse effects if occurred during the study was collected and entered in a specially designed proforma and MS word excel and analyzed by descriptive statistics like percentage.Results: Total 100 post-operative caesarean section inpatients were involved in the study. Most common indication for C-section was cephalopelvic disproportion. Average no of antibiotics per prescription was 3.32. Most commonly prescribed antibiotic was cefotaxime (27.71%) followed by gentamycin (25.90%) and metronidazole (24.59%). Majority (90%) of patients who admitted for ≤3 days (66%) had received combination antibiotic i.e., cefotaxime, metronidazole and gentamycin. IV fluids (21.21%) and analgesics (13.13%) were most frequently prescribed concomitant drugs. Majority (97.8%) of patients received parenteral preparation. 306 antibiotics (92.17%) used were from national model list of essential medicines (NLEM) and 332 antibiotics (100%). used were by generic name. Polypharmacy was 7.92.Conclusions: Cefotaxime was the most frequently prescribed antibiotic. Most of the antibiotics prescribed was rationally from NLEM and were by generic name.

Cesarean Section in the Delivery and Neonatal Center –Al-Saab-Aden Hospital from 1st Jan-31st Dec 2016

A caesarean section (CS) is a life-saving surgical procedure when certain complications arise during pregnancy and labour. However, it is a major surgery and is associated with immediate maternal and perinatal risks and may have implications for future pregnancies as well as long-term effects that are still being investigated.The aim of the study is to estimate the rate of CS to evaluate the most common indications of the operated CS, to estimated, and outline the most common types of CS in the delivery and neonatal center (Al-Saab-Aden Hospital).A retrospective analysis of clinical medical records of woman operated cesarean section and managed in the Department of Obstetrics and Gynecology at the Delivery and Neonatal Center -Al-Saab-Aden Hospital from 1st Jan to 31st December 2016.Out of 1532 deliveries over the study period from1st of Jan– 31st of Dec 2016, 312 cases had cesarean section representing 20.4% of total deliveries. More than half (52.9%) of cesarean section cases had repeated cesarean section and 77.2% in the Maternal age group 20 – 34 years, Cephalo-pelvic disproportion constitutes 14.7% of registered indications of CS, and the majority of C S due to previous one Scar (28.9%).The cesarean section rate still high with continuous increasing more than the rate stated by WHO. It is obvious that previous scare is the most common indications for CS. The decision to perform a CS must be maternity-centered and not technology-centered, in turn, lower the total cesarean delivery rate.

Prevalence, indications, and outcomes of caesarean section deliveries in Ethiopia: a systematic review and meta-analysis

BackgroundCaesarean section rates have increased worldwide in recent decades. Caesarean section is an essential maternal healthcare service. However, it has both maternal and neonatal adverse outcomes. Therefore this systematic review and meta-analysis aimed to estimate the prevalence, indication, and outcomes of caesarean section in Ethiopia.MethodsTwenty three cross-sectional studies with a total population of 36,705 were included. Online databases (PubMed/Medline, Hinari, Web of Science, and Google Scholar) and online university repository was used. All the included papers were extracted and appraised using the standard extraction sheet format and Joanna Briggs Institute respectively. The pooled prevalence of the caesarean section, indications, and outcomes was calculated using the random-effect model.ResultThe overall pooled prevalence of Caesarean section was 29.55% (95% CI: 25.46–33.65). Caesarean section is associated with both maternal and neonatal complications. Cephalopelvic disproportion [18.13%(95%CI: 12.72–23.53] was the most common indication of Caesarean section followed by non-reassuring fetal heart rate pattern [19.57% (95%CI: 16.06–23.08]. The common neonatal complications following Caesarean section included low APGAR score, perinatal asphyxia, neonatal sepsis, meconium aspiration syndrome, early neonatal death, stillbirth, and prematurity whereas febrile morbidity, surgical site infection, maternal mortality, severe anemia, and postpartum hemorrhage were the most common maternal complications following Caesarean section.ConclusionIn this systematic review and meta-analysis, the rate of Cesarean section was high. Cephalopelvic disproportion, low Apgar score, and febrile morbidity were the most common indication of Caesarean section, neonatal outcome and maternal morbidity following Caesarean section respectively. Increasing unjustified Caesarean section deliveries as a way to increase different neonatal and maternal complications, then several interventions needed to target both the education of professionals and the public.

Calcifying Fibrous Tumor of the Jejunum in a 27-year-old Primigravid: A Case Report

The most common mesenchymal tumors of the gastrointestinal tract are gastrointestinal stromal tumors (GIST) and smooth muscle neoplasms; however, other soft tissue tumors may also present in the intestines and cause diagnostic dilemmas. We report the case of a 27-year old primigravid, with no known complications, who underwent cesarean section for cephalopelvic disproportion. Intraoperatively, a well-demarcated, solid mass measuring 1.5 x 1.0 x 0.7 cm was noted at the jejunum. The patient underwent segmental resection of the mass. Microscopic examination of the mass reveals a non-encapsulated, solid mass composed of bland spindle cells and dense, hyalinized collagen in whorls and bundles. Dystrophic calcifications and a lymphoplasmacytic inflammatory infiltrate are seen within the collagen bundles. Immunohistochemical staining with desmin, CD117, and DOG-1 was done, which are all negative. The case was signed out as calcifying fibrous tumor (CFT). Inclusion of CFTs in the differential diagnoses for mesenchymal tumors of the gastrointestinal tract is important, as these neoplasms are benign and have an excellent prognosis.

Association Between Time of Day and the Decision for an Intrapartum Cesarean Delivery.

To examine whether the decision and indications for performing intrapartum cesarean delivery vary by time of day. We conducted a secondary analysis of a multicenter observational cohort of 115,502 deliveries (2008-2011), including nulliparous women with term, singleton, nonanomalous live gestations in vertex presentation who were attempting labor. Those who attempted home birth, or underwent cesarean delivery scheduled or decided less than 30 minutes after admission were excluded. Time of day was defined as cesarean delivery decision time among those who delivered by cesarean and delivery time among those who delivered vaginally, categorized by each hour of a 24-hour day. Primary outcomes were decision to perform cesarean delivery and the indications for cesarean delivery (labor dystocia, nonreassuring fetal status, or other indications). Secondary outcomes included whether a dystocia indication adhered to standards promoted to reduce cesarean delivery rates. Bivariate analyses were performed using χ and Kruskal-Wallis tests for categorical and continuous outcomes, respectively, and generalized additive models with smoothing splines explored nonlinear associations without adjustment for other factors. Seven thousand nine hundred fifty-six (22.1%) of 36,014 eligible women underwent cesarean delivery. Decision for cesarean delivery (P<.001) decreased from midnight (21.2%) to morning, reaching a nadir at 10:00 (17.9%) and subsequently rising to peak at 21:00 (26.2%). The frequency of cesarean delivery for dystocia also was significantly associated with time of day (P<.001) in a pattern mirroring overall cesarean delivery. Among cesarean deliveries for dystocia (n=5,274), decision for cesarean delivery at less than 5 cm dilation (P<.001), median duration from 5 cm dilation to cesarean delivery decision (P=.003), and median duration from complete dilation to cesarean delivery decision (P=.014) all significantly differed with time of day. The frequency of nonreassuring fetal status and "other" indications were not significantly associated with time of day (P>.05). Among nulliparous women who were attempting labor at term, the decision to perform cesarean delivery, particularly for dystocia, varied with time of day. Some of these differences correlate with labor management differences, given the changing frequency of latent phase cesarean delivery and median time in active phase.

INVESTIGATING THE FREQUENCY OF NORMAL VAGINAL DELIVERY AND CESAREAN SECTION AND CAUSES OF CESAREAN SECTION IN PUBLIC AND PRIVATE CENTERS AND COMPARING IT WITH EDUCATIONAL CENTERS IN ZAHEDAN

Introduction. Cesarean section plays an important role in decreasing the mortality and complications of childbirth in the mother and fetus. But the worrying issue in modern midwifery is the high rate of cesarean section. The current study was done to evaluate the frequency of normal vaginal delivery and cesarean section and the causes of cesarean section in public-private centers and compare it with educational centers in Zahedan in 2016-2017. Materials and methods. This is a descriptive cross-sectional study and a total of 792 deliveries were studied, 300 cases were from university hospitals and 492 from non-university hospitals in Zahedan. SPSS22 software was used for data analysis. Findings. The results disclosed that in university hospitals, 65.3 of the deliveries were normal vaginal delivery and 34.7 were cesarean, and in the non-university hospitals, 44.5 and 55.5 of the deliveries were normal and cesarean deliveries, respectively. There was a significant relationship between the type of delivery and the hospital where the delivery was done (P < 0.001). The most common causes of cesarean section in this study were: previous cesarean section (33.7), fetal distress (14.9), cesarean delivery on maternal request (CDMR) (11.7), delivery failure (11.4), mother's disease (7.4), abnormal fetal placement (6.6), multiparous pregnancy (4.5), problems with the placenta and umbilical cord (4), cephalopelvic disproportion (3.2) and embryonic diseases (2.7). There was no cesarean delivery on maternal request (CDMR) in university hospitals while in non-university hospitals it was 16.1. Conclusion. Generally, the percentage of normal vaginal delivery was higher than that of the cesarean section, but the number of cesarean sections was higher in non-university hospitals than in university hospitals. Also, ethnicity, number of pregnancy, job, education, history of infertility, and awareness of complications were significantly related to the type of delivery.

Development of CT Pelvimetry Using Deep Learning Based Reconstruction

X-ray pelvimetry is typically performed for the diagnosis of the cephalopelvic disproportion (CPD). The purpose of this study was to assess the utility of new computed tomography (CT) reconstruction "deep learning based reconstruction (DLR) " in ultra-low dose CT pelvimetry. CT pelvimetry was performed 320-row CT. All CT images were reconstructed with and without DLR and transferred for workstation to processing martius and guthmann view. Radiologist and obstetrician-gynecologist subjectively ranked overall image quality of each CT image from the best to the worst. Exposure dose of the CT pelvimetry used a following calculated value, displayed CT dose index (CTDI) vol multiplied by measured value using the thimble chamber and pelvic phantom, and of the X-ray pelvimetry used Japan-Diagnositic Refernce Levels 2015 as a reference, were compared. 3D images obtained from CT pelvimetry with DLR showed accurate biparietal diameter and obstetric conjugate as compared to without DLR. Radiation dose of CT pelvimetry is 0.39 mGy, of X-ray pelvimetry is 1.18 mGy, respectively. Conculusion: Although the visualizing high contrast object, such as bone morphology, is likely to reduce exposure dose in CT examination generally, DLR enable to further dose reduction to keep image quality. 3D image processing from CT pelvimetry solves the problem of expansion rate in X-P pelvimetry and provide accurate measurements. Furthermore, CT pelvimetry can undergo more comfortable position for Pregnant Woman in Labor.

Anaesthetic management of obstetric and nonobstetric emergencies during pregnancy

Background: Obstetric anaesthesia is considered to be one of the higher risk areas of anesthetic practice. The present study is done to know the various anesthetic techniques in management of obstetric emergencies and their complications. Materials & Methods: This was a descriptive study of 100 pregnant patients coming for emergency surgeries. Intraoperative complications such as hypotension, bradycardia, failed spinal, high spinal, seizures, difficult intubation and aspiration were recorded. Results: 78% of the obstetric emergencies were lower segment caesarean section, 16% was surgery for ectopic pregnancy, 3% hysterectomy for postpartum hemorrhage, 1% bartholin cyst excision, 1% I and D and 1% cervical encirclage. 90% of caesarean sections received subarachnoid block. 8% of cases received general anaesthesia and 2% of case subarachnoid block was converted to general anesthesia. 17 cases previous caesarean section in labour, in 13 cases thick meconium stained liquor with foetal distress, in 6 cases failure to progress, in 5 cases cephalopelvic disproportion, in 5 cases premature rupture of membranes and in 4 cases breech presentation in labour. Hypotension was present in 20 cases, bradycardia in 2 cases and failed spinal in 2 cases. Conclusion: Authors concluded that single shot subarachnoid block is the most common method of anaesthesia for emergency caesarean sections. Chickenpox is a worldwide disease and is no respecter race or class. The incidence increases in spring & winter months in the temperate zones. In the tropics, the peak incidence is during winter and early spring. The disease in fact started is helping the virus to spread rapidly.