Caesarean Section In Second Stage Research Articles

Correlation between maternal and umbilical cord 25-hydroxy-vitamin D levels over a range of values. A prospective observational study from the United Arab Emirates.

Worldwide vitamin D insufficiency is remarkably prevalent in both children and adults, including pregnant women. The total amount of the vitamin is best measured by 25-hydroxy-vitamin D (25(OH)D), which is a measurement of total serum cholecalciferol 25(OH)D3 and ergocalciferol 25(OH)D2. There is a known correlation between maternal and umbilical cord blood (UCB) 25(OH)D; however, whether specific maternal demographics or comorbidities influence the correlation remains uncertain. This prospective observational study was designed to study if maternal 25(OH)D levels, maternal age and BMI, amount of supplementation, mode of delivery, diabetes, hypertension/preeclampsia, or sunlight exposure had an impact on the correlation. Women were enrolled in the study at admission to the labor ward. If they agreed to participate, venous blood was directly collected and analyzed for 25(OH)D. The UCB was sampled after delivery from the unclamped cord and immediately analyzed for 25(OH)D. ANOVA, Fisher's exact test, Pearson's correlation, and test of the differences between correlations using Fisher's z-transformation with Bonferroni correction were used accordingly. Of the 298 women enrolled, blood from both the mother and umbilical cord was analyzed successfully for 25(OH)D in 235 cases. The crude correlation between maternal and UCB 25(OH)D was very strong over all values of 25(OH)D (r = 0.905, R2 = 0.821, p <0,001) and remained strong independently of maternal demographics or co-morbidities (r ≥ 0.803, R2 ≥ 0.644, p <0.001). For women who delivered by caesarean section in second stage the correlation was strong (r ≥ 0.633, R2 ≥ 0.4, p <0.037). Test of differences between correlations showed significant stronger correlation in women with unknown 25(OH)D3 supplementation compared to women receiving 10.000 IU/week (p = 0.02) and 20.000IU/week (p = 0.01) and that the correlation was significantly stronger for women with a BMI of 25-29.9 compared to women with a BMI of <24.9 (p = 0.004) and 30-34.9 (p = 0.002). 213 (91%) women had lower 25(OH)D compared to the neonate, with a mean difference of -13.7nmol/L (SD = 15.6). In summary, the correlation between maternal and UCB 25(OH)D is very strong throughout low to high maternal levels of 25(OH)D with lower levels in maternal blood. Typical maternal demographics and comorbidities did not affect the transition.

"It's complicated…": Exploring second stage caesarean sections and reasons for non-performance of assisted vaginal births in Kenya: A mixed methods study.

Unnecessary Caesarean Section (CS) can have adverse effects on women and their newborns. Assisted vaginal birth/delivery (AVB/AVD) using a suction device or obstetric forceps is a potential alternative when delays or complications occur in the second stage of labour. Unlike CS, AVB using a suction device does not require regional or general anaesthesia, can often be performed by midwives, and does not scar the uterus, lowering the risk of maternal mortality and morbidity, in this and subsequent pregnancies. This study examined the appropriateness and outcomes of second stage CS (SSCS), and reasons for low levels of AVB use, in Kenya. Using a mixed methods study design, we reviewed case notes from women having SSCS births and AVB, and conducted key informant interviews with healthcare providers, from 8 purposively selected hospitals in Kenya. Randomly selected SSCS and all AVB case notes were reviewed by a panel of four experienced obstetricians, and appropriateness of the procedure assessed. Semi-structured interviews were conducted with obstetricians, medical officers and midwives, and analysed using a thematic approach. Review of 67 SSCS case notes showed 10% might have been conducted as AVBs, with a further 58% unable to be classified due to inadequate/inconsistent record keeping or excessive delay following initial CS decision. Outcomes following SSCS showed perinatal mortality rate of 89.6/1,000 births, with 11% of infants and 9% of mothers experiencing complications. Non-referred cases of AVB showed good outcomes. The findings of the 20 interviews explored the experience and confidence of healthcare providers in performing AVBs, and adequacy of the training they received. Key reasons for non-performance included lack of functioning equipment, lack of trained staff or their rotation to other departments. Reasons for non-performance of AVB were complex and often multiple. Any solutions to these problems will need to address various local, regional and national issues.

Forceps Use in Rotational and Non-Rotational Vaginal Delivery

Forceps are a commonly used instrument for assisting vaginal delivery. Accepted indications include prolonged labour, suspected fetal distress and maternal medical conditions that benefit from a shortened second stage of labour. Maternal and offspring outcomes of forceps-assisted birth have been extensively reported in observational studies, but randomized trial evidence is limited. Forceps-assisted delivery has a lower failure rate than vacuum-assisted delivery but is associated with a higher incidence of maternal pelvic floor trauma. Second-stage caesarean section is associated with less fetal-neonatal trauma than forceps-assisted delivery but markedly reduces the chance of a subsequent vaginal birth. This review outlines the existing evidence on prevention, indications, and contraindications for forceps-assisted birth (non-rotational and rotational), short- and long-term complications for mother and baby, alternatives to use of forceps and how to manage an abandoned forceps-assisted birth. The essential components of informed consent are also discussed.

Maternal and neonatal complications following Kielland's rotational forceps delivery: A systematic review and meta-analysis.

There is conflicting evidence regarding the safety of Kielland's rotational forceps delivery (KRFD) in comparison with other modes of delivery for the management of persistent fetal malposition in the second stage of labour. To derive estimates of risks of maternal and neonatal complications following KRFD, compared with rotational ventouse delivery (RVD), non-rotational forceps delivery (NRFD) or a second-stage caesarean section (CS), from a systematic review and meta-analysis of the literature. Standard search methodology, as recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Case series, prospective or retrospective cohort studies and population-based studies. A meta-analysis using a random-effects model was used to derive weighted pooled estimates of maternal and neonatal complications. Thirteen studies were included. For postpartum haemorrhage there was no significant difference between Kielland's and ventouse delivery; the rate was lower in Kielland's delivery compared with non-rotational forceps (RR0.79, 95%CI 0.65-0.95) and second-stage CS (RR0.45, 95%CI 0.36-0.58). There were no differences in the rates of anal sphincter injuries or admission to neonatal intensive care. Rates of shoulder dystocia were higher with Kielland's delivery compared with ventouse delivery (RR1.79, 95%CI 1.08-2.98), but rates of neonatal birth trauma were lower (RR0.49, 95%CI 0.26-0.91). There were no differences seen in the rates of 5-min APGAR score < 7 between Kielland's delivery and other instrumental births, but they were lower when compared with second-stage CS (RR0.47, 95%CI 0.23-0.97). Kielland's rotational forceps delivery is a safe option for the management of fetal malposition in the second stage of labour.

Vacuum extraction or caesarean section in the second stage of labour: A systematic review.

Prolonged second stage of labour is an important cause of maternal and perinatal morbidity and mortality. Vacuum extraction (VE) and second-stage caesarean section (SSCS) are the most commonly performed obstetric interventions, but the procedure chosen varies widely globally. To compare maternal and perinatal morbidity, mortality and other adverse outcomes after VE versus SSCS. A systematic search was conducted in PubMed, Cochrane and EMBASE. Studies were critically appraised using the Newcastle-Ottawa scale. All artictles including women in second stage of labour, giving birth by vacuum extraction or cesarean section and registering at least one perinatal or maternal outcome were selected. The chi-square test, Fisher exact's test and binary logistic regression were used and various adverse outcome scores were calculated to evaluate maternal and perinatal outcomes. Fifteen articles were included, providing the outcomes for a total of 20 051 births by SSCS and 32 823 births by VE. All five maternal deaths resulted from complications of anaesthesia during SSCS. In total, 133 perinatal deaths occurred in all studies combined: 92/20 051 (0.45%) in the SSCS group and 41/32 823 (0.12%) in the VE group. In studies with more than one perinatal death, both conducted in low-resource settings, more perinatal deaths occurred during the decision-to-birth interval in the SSCS group than in the VE group (5.5% vs 1.4%, OR4.00, 95%CI 1.17-13.70; 11% vs 8.4%, OR1.39, 95%CI 0.85-2.26). All other adverse maternal and perinatal outcomes showed no statistically significant differences. Vacuum extraction should be the recommended mode of birth, both in high-income countries and in low- and middle-income countries, to prevent unnecessary SSCS and to reduce perinatal and maternal deaths when safe anaesthesia and surgery is not immediately available.

Duration of the second stage of labour and risk of subsequent spontaneous preterm birth.

To determine the risk of spontaneous preterm birth (sPTB) associated with the length of second stage of labour in the first term delivery. Retrospective cohort study. University hospital. Women with first two consecutive singleton births and the first birth at term. Those who did not reach the second stage of labour in the first delivery were excluded. Charts from 2007 to 2019 were reviewed. Rate of sPTB (<37weeks of gestation) in the second delivery. Of 13958 women who met study inclusion criteria, 1464 (10.5%) parturients had a prolonged second stage (≥180min) in their first term delivery. The rate of sPTB in the second delivery was similar in those with and without a prolonged second stage in first delivery (2.8% versus 2.8%; adjusted odds ratio [aOR] 1.35, 95% CI 0.96-1.90). After adjustment for mode of delivery, prolonged second stage was also not associated with subsequent sPTB in those who delivered by spontaneous and operative vaginal delivery. Those delivered by second-stage caesarean section in the first delivery had a higher risk of sPTB in the second delivery (25/526, 4.8%; aOR 2.66, 95% CI 1.71-4.12; p<0.001), with a more pronounced risk in those with second-stage caesarean following a prolonged second stage of labour (15/259, 5.8%; aOR 3.40, 95% CI 1.94-5.94; p<0.001). Second-stage duration in a first term vaginal delivery is not associated with subsequent sPTB. The risk of sPTB is increased following second-stage caesarean section, particularly if performed after a prolonged second stage. Second-stage caesarean delivery, particularly after prolonged second stage, increases the risk of preterm birth.

A hospital-based assessment of the complications of caesarean section during second stage of labor: An observational study

Aim: To evaluate the maternal and neonatal outcome of caesarean section in second stage of labour. Material and Methods: This observational study was carried out in the Department of Obstetrics and Gynecology, Mamata Academy of Medical Sciences, Bachupally, Hyderabad, India, for the period of 1 year. Total 200 patients were included into the study. All caesarean sections performed at full cervical dilatation over this time period. Results: Among the 200 patient’s majority of them were in the age group of 20-30 years (73.5%). about 77.5% of the patients were primigravidae and only the remaining 22.5% were multigravida. 82.5% of patients from BPL socioeconomic class and 17.5% only from APL socioeconomic class. The commonest indications for doing caesarean section in the second stage of labour were cephalo pelvic disproportion, fetal distress and obstructed labour. Incidence of PPH was 27 out of 200 cases (13.5%). Post-operative wound infection was seen in 12(6%) and post-operative fever was seen in 32(16%) out of 200 cases. There were no cases of maternal deaths reported. The mean operative time was 51.7 min. The mean length of hospital stays was 6.8 days. Mean weight of the babies of the second stage caesarean section was 3.4 kg. 11 (5.5%) babies were admitted to the Neonatal Intensive Care Unit and 26 (13%) to neonatal nursery for management of respiratory distress, sepsis, jaundice, and observation. 25 (12.5%) babies had Neonatal jaundice and There were 2 neonatal deaths reported. Conclusion: Caesarean sections during the second stage are increasing in prevalence and are associated with significant long-term psychological and physical maternal morbidity.

Impacted fetal head: A retrospective cohort study of emergency caesarean section

ObjectiveTo investigate risk factors, management and outcomes of impacted fetal head (IFH) at caesarean section (CS). Study designThis is a retrospective cohort study of all women with singleton, cephalic pregnancies who had an emergency CS during one-year (2016) at North Bristol NHS Trust, UK (n = 838).The incidence of caesarean section at full dilatation (CSFD) and IFH were calculated using the annual birth rate. To identify risk factors for IFH, maternal, perinatal and intrapartum characteristics were compared according to the presence or absence of IFH, and separately for first- and second-stage CS. Techniques employed to disimpact the fetal head were described. Univariable and multivariable comparisons of maternal and perinatal outcomes were made between cases with and without an IFH. Characteristics and outcomes were compared using modified Poisson regression. ResultsCSFD accounted for 2.1 % of all births. IFH complicated 1.5 % of all births (11.3 % of emergency CS), with 55.8 % occurring prior to full cervical dilatation.Increased rates of IFH at CS were associated with: oxytocin augmentation (RR = 2.47 [1.61–3.80]), full cervical dilatation (RR = 4.24 [2.96–6.07], mid/low station (RR = 4.14 [2.72–6.32]), moulding (RR = 4.39 [2.55–7.54]) and caput (RR = 6.60 [3.09–14.10]). Junior operators documented IFH more than consultants (RR = 9.61 [1.35–68.2]).The strategies recorded for managing IFH included: tocolysis, reverse breech extraction and vaginal push up (33.7 %, 14.7 % and 11.6 % cases respectively) with two or more techniques used in 21.1 % cases.IFH at CS was independently associated with an increased risk of uterine extensions (RR = 3.09 [1.96–4.87]) and a composite adverse perinatal outcome (RR = 1.66 [1.21–2.28]). ConclusionsIFH is a common and heterogeneous complication associated with increased complications for both mother and baby, independent of those of CSFD. Obstetricians must remain vigilant to the possibility of IFH at all emergency CS, particularly those at full cervical dilatation or with evidence of obstructed labour. There is an urgent need for a standardised management algorithm and training in evidence-based disimpaction techniques.

454 Pregnancy outcome after cesarean section following a failed vacuum attempt

To compare pregnancy outcome of women who underwent cesarean section (CS) in second stage of labor, with or without a following failed vacuum extraction attempt (VE). A retrospective cohort study of women who underwent cesarean section during the second stage of labor in a single tertiary university affiliated medical center (2012-2019). Pregnancy outcome was compared for women who underwent cesarean section following a failed vacuum extraction to women who had cesarean section during the second stage of labor with no vacuum extraction attempt. Neonatal outcomes included umbilical artery pH less than 7.1, Apgar at 5 minutes < 7, hypoxemic ischemic encephalopathy and NICU admission. Maternal outcomes included duration of hospitalization, need for blood transfusion and need for re-surgery in 45 days. Overall, 88,375 women delivered during the study period. Of them, 120 women had a cesarean section following failed vacuum (study group). Another 551 women underwent cesarean section in the second stage of labor without VE attempt (control group). The groups were similar with regard to obstetrical and demographic characteristics. The rates of umbilical artery pH<7.1 (17.50% vs 6.53%, p<0.001), NICU admission (13.33% vs 2.90%, p<0.001), hypoxemic ischemic encephalopathy (5.83% vs 0.18%, p<0.001) and epicranial sub-aponeurotic hemorrhage (16.67% vs 2.18%, p<0.001) were significantly higher in the study group. No significant differences were found in maternal outcomes. In a sub-analysis including only labor with reassuring fetal heart tracing, failed vacuum attempt was associated with higher rate of NICU admission and epicranial hemorrhage (16.67% vs 3.13%, p=0.009, 27.78% vs. 3.41, p=0.001, respectively). Failed vacuum attempt is associated with a significant increased neonatal morbidity, but not increased maternal morbidityView Large Image Figure ViewerDownload Hi-res image Download (PPT)

Maternal outcomes following second stage caesarean section in a tertiary hospital in Malaysia: A 6-year retrospective review

Introduction: The trend for second stage caesarean section (SSCS) has been rising, and it carries a high rate of maternal and neonatal morbidity. Aim: To determine the prevalence of caesarean section (CS) performed during the second stage of labour and identify maternal outcomes and associated risk factors in these women. Material and methods: This retrospective study was performed in the Hospital University Sains Malaysia (HUSM). Medical records of 207 women with singleton cephalic pregnancies at term who underwent a SSCS between January 1, 2010 and December 31, 2015 were reviewed, and demographic and outcome data were collected. Results and discussion: During the study period, 8,197 (19.3%) out of 42,546 babies were delivered by CS, including 257 (4.1%) SSCSs. Nearly half (49.3%) the women were nulliparous, 182 (87.9%) experienced spontaneous labour and 123 (59.4%) received oxytocin augmentation. Furthermore, 26 (12.6%) of women had post-partum haemorrhage (≥1000 mL), of whom 22 (10.6%) required blood transfusion. Only 1 (0.5%) woman was admitted to the intensive care unit postoperatively, but 163 (78.7%) had an overall hospital stay length of 3 days. Furthermore, 38 (18.4%) and 33 (15.9%) of women experienced extended uterine tear and uterine atony, respectively. Parity (P &lt; 0.001), attempted instrumentation (P &lt; 0.001) and baby’s weight (P &lt; 0.004) were statistically significantly associated with total blood loss. Parity (P &lt; 0.012) and attempted instrumentation (P &lt; 0.001) were risk factors for extended uterine tear. Conclusions: The overall outcomes from SSCS were better compared with studies performed in other centres. Current practices must be maintained or improved to provide the best patient caree.

Fetomaternal Outcomes between Instrumental Vaginal Delivery and Caesarean Section in Second Stage of Labour: A Prospective Interventional Study

Fetomaternal Outcomes between Instrumental Vaginal Delivery and Caesarean Section in Second Stage of Labour: A Prospective Interventional Study

FETO-MATERNAL OUTCOME OF CAESAREAN SECTION DURING SECOND STAGE OF LABOR IN A TERTIARY CARE HOSPITAL: AN OBSERVATIONAL STUDY

Aim: To highlights the maternal and neonatal outcome of caesarean section in second stage of labour.&#x0D; Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynecology at Government Medical College and Hospital Bettiah, Bihar, India from December 2017 to December 2018. total of 24600 women delivered by caesarean section, 16800 emergency and 7800 elective cases. Of these 400 were at full cervical dilatation, &gt;37 weeks gestation with a singleton fetus in cephalic presentation. All caesarean sections performed at full cervical dilatation over the time period of 1 year at a government hospital were included.&#x0D; Results: Among the 400 patient’s majority of them were in the age group of 20-30 years (72.5%). about 75.5% of the patients were primigravidae and only the remaining 24.5% were multigravida. The commonest indications for doing caesarean section in the second stage of labour were cephalo pelvic disproportion, fetal distress and obstructed labour. Incidence of PPH is 48 out of 400 cases (12%). Post-operative wound infection was seen in 23(5.75%) and Post-operative fever was seen in 70(17.5%) out of 400 cases. There were no cases of maternal deaths reported. The mean operative time was 52.9 min .The mean length of hospital stays was 6.6 days. Mean weight of the babies of the second stage caesarean section was 3.2 kg.&#x0D; Conclusions: Caesarean sections done in second stage of labour are associated with several intra-operative maternal complications and neonatal morbidity.&#x0D; Keywords: Caesarean complications; emergency caesarean section; maternal morbidity; neonatal morbidity

Cephalic extraction versus breech extraction in second-stage caesarean section: a retrospective study.

Our primary objective was to compare maternal and neonatal outcomes based on the attempted mode of extraction. Our secondary objective was to compare the outcomes based on the actual mode of extraction. A retrospective cohort study at a single tertiary centre between the years 2011 and 2019. The study included 1028 cases of term pregnancies in vertex presentation that were delivered by caesarean section at the second stage of delivery. Patients were grouped according to the attempted mode of extraction: attempted cephalic extraction (674) and breech extraction (354). A subgroup analysis was conducted, comparing successful cephalic extraction (615), failed cephalic extraction (59) and breech extraction (354). Both maternal and neonatal complication rates were compared between the groups. There were significantly more uterine incision extensions (27.4 versus 11.9%, P<0.001) and increased need for blood transfusion (10.7 versus 6.2%, P=0.018) in the cephalic extraction compared with the breech extraction group. The highest rate of uterine incision extensions (45.8%) and need for blood transfusion (22%) was in the subgroup of failed cephalic extraction. The rate of adverse neonatal outcomes was comparable between the two groups. However, in the subgroup of failed cephalic extraction, there were higher rates of low 1-minute Apgar scores, NICU hospitalisation and limb fractures compared with successful cephalic extractions and breech extractions (P=0.016, 0.01, <0.001, respectively). Breech extraction in second-stage caesarean section is associated with fewer maternal complications compared wiith attempted cephalic extraction without increasing neonatal complication rates. In breech versus cephalic extraction, breech extraction was found to have better outcomes in second-stage caesarean section.

Perinatal outcomes of babies delivered by second-stage Caesarean section versus vacuum extraction in a resource-poor setting, Nigeria \u2013 a retrospective analysis

BackgroundTo evaluate the perinatal status of neonates delivered by assisted vaginal delivery (AVD) versus second-stage caesarean birth (CS).MethodsA 5-year retrospective study was conducted in a tertiary hospital. Data was analyzed with IBM SPSS® version 25.0 statistical software using descriptive/inferential statistics.ResultsA total of 559 births met the inclusion criteria; AVD (211; 37.7%) and second-stage CS (348; 62.3%). Over 80% of the women were aged 20–34 years: 185 (87.7%) for the AVD group, and 301 (86.5%) for the second-stage CS group. More than half of the women were parous: 106 (50.2%) for the AVD group, and 184 (52.9%) for the second-stage CS group. The commonest indication for intervention in both groups is delayed second stage: 178 (84.4%) in the AVD group, and 239 (68.9%) in the second-stage CS group. There was a statistically significant difference in decision to delivery interval (DDI) between both groups: 197 (93.4%) women in the AVD group had DDI of less than 30 min and 21 women (6.0%) in the CS group had a DDI of less than 30 min (p < 0.001). During the DDI, there were 3 (1.4%) intra-uterine foetal deaths (IUFD) in the AVD and 19 (5.5%) in the CS group (p = 0.023). After adjusting for co-variates, there were statistically significant differences between the AVD and CS groups in the foetal death during DDI (p = 0.029) and perinatal deaths (p = 0.040); but no statistically significant differences in severe perinatal outcomes (p = 0.811), APGAR scores at 5th minutes (p = 0.355), and admission into the NICU (p = 0.946). After adjusting for co-variates, use of AVD was significantly associated with the level of experience of the care provider, with resident (junior) doctors less likely to opt for AVD than CS (aOR = 0.45, 95% CI: 0.29–0.70).ConclusionSecond-stage CS when compared with AVD was not associated with improved perinatal outcomes. AVD is a practical option for reducing the rising Caesarean delivery rates without compromising the clinical status of the newborn.

Association between rates of second-stage Caesarean section and instrumental delivery

Association between rates of second-stage Caesarean section and instrumental delivery

Comparison of ‘push method’ with ‘Patwardhan’s method’ on maternal and perinatal outcomes in women undergoing caesarean section in second stage

A deeply impacted foetal head in a second stage caesarean section is associated with an increased risk of maternal and neonatal complications. For the present study, we compared the maternal and neonatal outcomes during the use of the ‘Push method’ and of ‘Patwardhan’s method’ for a foetal head delivery in a second-stage caesarean section. This was a retrospective observational study involving 298 women who underwent a second stage caesarean section with a foetal head at or below the level of their ischial spines and was conducted in a tertiary teaching hospital in South India. The rates of uterine incision extension and other maternal complications were similar in both methods (24.9% vs. 26.0%, p = .850). The rates of neonatal sepsis (2.3% vs. 9.2%) and admission to neonatal intensive care unit (36.7% vs. 60.0%) were higher when Patwardhan’s method was used. Although the maternal complications were similar, the use of Patwardhan’s method resulted in higher rates of neonatal complications compared to the Push method during a second stage caesarean section. Future randomised, controlled studies comparing these two methods are needed to confirm their safety and benefits, prior to its routine use in second stage caesarean sections. Impact statement What is already known on this subject? Use of a second-stage caesarean section increases the risk of maternal and neonatal complications. A deeply engaged foetal head, along with the stretching and thinning of the lower uterine segment predisposes to these complications. The recent literature mainly compares the complication rates of the Push method to a Reverse breech extraction, with only small studies reporting the use of Patwardhan’s technique for the delivery of a deeply engaged foetal head. What do the results of this study add? This study suggests that the use of either the Push method or of Patwardhan’s method results in similar maternal complications such as extension of a uterine incision or postpartum haemorrhage. But neonatal complications such as neonatal sepsis (2.3% vs. 9.2%) and admission to neonatal intensive care unit (36.7% vs. 60.0%) were higher when Patwardhan’s method was used. What are the implications of these findings for clinical practice and/or further research? The extension of uterine incision is similar in both methods; however, the neonatal complications were noted to be higher in those delivered with Patwardhan’s technique. A future, randomised controlled trial comparing these two techniques is required to confirm the findings, before either of the methods are used in routine practice.

Lower Segment Cesarean Section in Second Stage of Labor: Comparison of Patwardhan Method with Conventional Pushing Method (A 3-year Study)

Lower Segment Cesarean Section in Second Stage of Labor: Comparison of Patwardhan Method with Conventional Pushing Method (A 3-year Study)

Birthing experience and quality of life after vacuum delivery and second-stage caesarean section: a prospective cohort study in Uganda.

To assess perceptions of women undergoing vacuum extraction or second-stage caesarean section (SSCS) in a tertiary referral hospital in sub-Saharan Africa. Prospective cohort study, with six-month follow-up, of women who gave birth to a term singleton in cephalic presentation by vacuum extraction (n=289) or SSCS (n=357) between 25 November 2014, to 8 July 2015, in Mulago Hospital, Uganda. Excluded were women who had failed vacuum extraction, severe birth complications and those whose babies had died. Outcome measures were birthing experience satisfaction, physical component summary (PCS) and mental component summary (MCS) of the SF-12 quality-of-life questionnaire, pain scores and dyspareunia. One day after vacuum extraction, 63.7% (181/284) of women were feeling well vs. 48.1% (167/347) after SSCS (OR 1.89; 95%CI 1.37-2.61) and mean pain sores were 2.70 vs. 3.87 (P<0.001). In both groups, >90% of women were satisfied with their birthing experience. At six weeks, in vacuum extraction vs. SSCS, mean pain sores were 0.40 vs. 0.89 (P<0.001); mean PCS was 48.67 vs. 44.03 (P<0.001); mean MCS was 52.80 vs. 51.23 (P=0.203); 40% (70/175) vs. 28.3% (70/247) of women had resumed sexual intercourse (OR 1.69; 95%CI 1.12-2.54) and 21.4% (15/70) vs. 28.6% (20/70) had dyspareunia (OR 0.68; 95%CI 0.32-1.47). No differences were found at six months after birth. One day and six weeks after birth, outcomes were better in women who had vacuum extraction. At six months, outcomes were similar. To promote quick recovery, vacuum extraction should be the first intervention considered in the second stage of labour.

An evaluation of the indications for caesarean sections at Chris Hani Baragwanath Academic Hospital

Background. A systematic review concluded that a caesarean section (CS) performed for medical indications will save lives; however, it is associated with short- and long-term complications. The CS rate at Chris Hani Baragwanath Academic Hospital (CHBAH) was 39.78% in 2015. Objectives. To evaluate the indications for CSs at CHBAH. Methods. This was a cross-sectional study conducted on the data collected in the week of 23 June to 29 June 2015. Each file was evaluated for the correctness of the decision by at least two researchers. Each reviewer could state that he/she absolutely agreed, partially agreed, did not agree or could not make an assessment. Results. The mean (standard deviation (SD)) age of the women was 27.01 (6.35) (range 15 - 44) years. The median (interquartile range (IQR)) parity was 1 (0 - 2) (range 0 - 4). No co-morbidities were found in 13.6% ( n =20) of the reviewed cases. Complications were found to have occurred in 17% ( n =25) of women who gave birth over the week reviewed. The median (IQR) gestational age at delivery was 38.14 (36.39 - 40.14) (range 28.0 - 42.4) weeks. The median (IQR) Apgar (5 minutes) was 10 (9 - 10) (range 0 - 10). The median (IQR) birth weight was 3 040 (2 530 - 3 440) (range 825 - 4 575) g. The most common indications were fetal distress ( n =73; 49.66%) and dystocia ( n =42; 28.57%). There was absolute agreement between the two reviewers in the following: retained second twin, antepartum haemorrhage (APH) of unknown origin, placenta previa, severe intrauterine growth restriction, multiple pregnancy, abnormal presentation, eclampsia and two previous CSs. When the indication was fetal distress, dystocia, second-stage CS, or one previous CS, the absolute agreement was between 73.85% and 90.24%. Conclusion. There were few absolute disagreements with the indication cited. Methods used to diagnose fetal distress and dystocia must be evaluated

Caesarean Section During Second Stage of Labor in a Tertiary Centre.

There is an alarming rise in caesarean section leading to increased adverse outcomes for both the mother and fetus when compared with vaginal delivery. Within this increasing caesarean section rate, there is a concerning increase in the rate of second stage caesarean section. This study highlight the feto-maternal outcome of caesarean section in second stage of labour. This was a retrospective cohort review of all women with a singleton, cephalic fetus at term delivered by caesarean section in the second stage of labor between April 1, 2013 and March 30, 2017 at Patan Academy of Health Sciences. The main outcome measures were second stage caesarean section, indications and its maternal and fetal morbidity. During the study period, there were 40,860 deliveries. A total of 18,011 (44%) babies were born by caesarean section, 10484 emergency and 7527 elective. Out of the emergency caesarean section, 200 (1.9 %) were performed in second stage of labor. In this study, the most common indication was cephalopelvic disproportion. (92.4%) were delivered without a trial of instrumental delivery. In terms of maternal complications, atonic post partum haemorrhage uterine incision extension 18 (12.5%), postoperative fever 27(18.8%), wound infection 7 (4.8%) were observed. In perinatal complications, meconium stained amniotic fluid 49(34.2%), neonatal hyperbilirubinemia 14(9.7%) and increased nursery admission 2(15.3%) and 2(1.3%) perinatal mortality were seen. Cesarean sections done in second stage of labor are associated with several intra-operative maternal complications and neonatal morbidity.