Cesarean Research Articles

Simulation for intrapartum care: from training to novel device innovation.

Improving maternal and perinatal care is a global priority. Simulation training and novel applications of simulation for intrapartum care may help to reduce preventable deaths worldwide. Evaluation studies have published details of the effectiveness of simulation training for obstetric emergencies, exploring clinical and non-clinical factors as well as the impact on patient outcomes (both maternal and neonatal). This review summarises the many uses of simulation in obstetric emergencies from training to assessment. It also describes the adaption of training in low-resource settings and the evidence behind the equipment recommended to support simulation training. The review then discusses more novel applications for simulation such as its use in the development of a new device for assisted vaginal birth and its potential role in Caesarean section training. It further discusses the financial implications of simulation training and how this may impact the delivery of such training packages. It presents a concept that simulation should be developed and utilised as a key tool in the development of safe intrapartum care in both emergency and non-emergency settings, in innovation and product development.

Numerical Analysis and Design Method of Cold-Formed Thin-Walled C-Section Steel Perforated Member

Numerical Analysis and Design Method of Cold-Formed Thin-Walled C-Section Steel Perforated Member

Construction of women’s autonomy towards choosing the mode of delivery

Introduction: Choice of mode of childbirth by women has been addressed for some decades. In Brazil, cesarean delivery rates reached 55% in 2018 and, according to doctors, this is mainly due to women ́s request. Understanding how women perceive autonomy in choosing the mode of childbirth is, though, important. Bioethics allows us to reflect broadly on the issue. Objectives: There are many ways to view the autonomy, thus, this paperwork goal is to understand how women who had recently given birth viewed their empowerment over choosing their mode of delivery and also draw a possible path of autonomy construction or the lack of it that may contribute to giving women more empowerment over choosing their mode of delivery. Methodology: A questionnaire was applied to ten women who gave birth for the first time within 12 and 48 hours after labor in a specific hospital between July of 2019 and November of 2019. Then, the interviews were analyzed using Bardin’s content analysis method. Results: Financial expenditures and work: within the 10 interviewed women, 7 referred to work and/or split their home expenses which was a way to see whether they had financial autonomy or not. The women’s empowerment also reflects their reproductive planning and their anti-pregnancy chosen methods. Contraception: it was observed that some of our interviewees did not participate on the contraception choices, despite the existing concern on educative practice, because they were reduced to an informative moment showing off that the health professional is the knowledge owner and the woman does not actively participate of the contraception and pregnancy planning. But the questionnaire was not effectively implemented to assess further information on this issue. Preliminary information and Healthcare professionals: childbirth preliminary information is essential to women’s full autonomy on the pregnancy. However, in the current assistance system it is seen an asymmetric relationship between the physician and the pregnant woman by not prioritizing the women’s knowledge over their bodies and reproduction processes which were observed in most of the interviews. Decision and mode of delivery choosing participation: only one of the interviewed women referred that she did not participate in the mode of delivery choice. However, despite choosing their mode of delivery, 6 interviewed women had shown that they had no autonomy on other areas of life that the questionnaire came up - financial expenditures and work, contraception, information about labor and decision and participation on choosing the mode of delivery. Discussion: The obtained data allowed us to imply that there are flaws in the women’s autonomy construction mainly about the mode of delivery which affects directly on choosing it, even though sometimes the woman believes she has chosen, but she didn’t know her options and by not knowing it she did not have a complete autonomy over her choices, indicating that there’s a long path in order to women to conquer the right of choosing the mode of delivery of their children. Conclusion: Women’s autonomy construction is affected by many factors. Health professional information is essential to this process, and the lack of it may directly affect the choice of the mode of delivery by women.

Escolha do tipo de parto: avaliação do protagonismo da mulher

Objetivou-se identificar os tipos de partos empregados para o nascimento em crianças de um hospital de referência, elencando o processo de decisão para referida técnica. Trata-se de pesquisa qualitativa, elaborada com 76 puérperas imediatas, em um municí­pio de médio porte no noroeste do Paraná, nos meses de abril e maio de 2019. Utilizou-se como instrumento de pesquisa um questionário objetivo com o intuito de levantar informações sociodemográficas e sobre a escolha do parto. Os dados revelaram que a grande maioria realizou o número de consultas pré-natal recomendado. No entanto, 64% não foi esclarecida sobre as particularidades de cada tipo de parto pelos seus médicos. No tocante í escolha da modalidade de parto no iní­cio da gravidez, 72% disseram preferir o parto normal, porém houve um declí­nio no número de gestantes que efetivamente realizaram o parto natural. Conclui-se que apesar da preconização da Organização Mundial da Saúde (OMS), ní­veis superiores ao esperado para cesárea têm sido realizados.

Transfusion management of abdominal delivery in pregnant women at high risk of bleeding with hemostasis control

Objective of the study . Optimization of transfusion support of abdominal delivery in pregnant women at risk of obstetric haemorrhage using monitored management of haemostasis disorders. Study materials. The study group consisted of 24 women of 23-47 years old with abnormal placental invasion (API) and bleeding during caesarean section at a gestational age of 32-36 weeks. Group 1 consisted of 14 patients, who were injected with tranexamic acid as part of combined therapy; Group 2 consisted of 10 women, who were injected with aminomethylbenzoic acid as part of combined therapy. Results. All patients received instrumental autoerythrocyte reinfusion. Three patients of Group 1 (21.4%) with refractory bleeding received recombinant coagulation factor VIIa (Coagil, Russia) at a dose of 60 pg/kg body weight (average dose 6.6 ± 1.4 mg), a decrease in bleeding was observed, the operative treatment was completed in the form of metroplasty. In the early stages of bleeding, eight patients were injected with a prothrombin complex concentrate of 600-1,200 IU before administration of fresh-frozen plasma (FFP), which allowed to reduce the volume of donor FFP in these patients. The study of hemostasis showed a very high inverse relationship between extent of blood loss and fibrinogen level in the groups of patients. Conclusion. The use of factor VIIa in refractory major obstetric haemorrhage (MOH) in patients with API allows to reduce the blood loss, perform metroplasty, and preserve the woman’s fertility. Patient blood management (PCM) in pregnant women with API makes it possible to conduct organ-preserving treatment in 91.7% of women.

A modern view of the caesarean section (review)

The problem of caesarean section has medical and economic aspects, is relevant and widely discussed in the literature. In the modern world, caesarean section in frequency of execution surpasse all other abdominal operations. The review considers the reasons for the increase in the frequency of caesarean section and the possibility of reducing these indicators. The methods of anesthesia during caesarean section, the moments of pharmaceutical perioperative support, issues of complications in the postoperative period are described. Examples of successful abdominal delivery with a combined other pathology are given.

Angle of progression in women undergoing trial of labor after cesarean section in predicting mode of delivery

Objective To assess the ability of ultrasonic measurement of angle of progression (AOP) in predicting mode of delivery in women undergoing vaginal birth after cesarean section (CS). Background The intrapartum ultrasound measurement of AOP is reliable regardless of the fetal head station assessed manually or the clinician's level of ultrasound experience. Patients and methods A prospective observational study was conducted from March 2019 to January 2020 at Menoufia University Hospital, including 100 patients with a history of previous one CS in spontaneous labor. Patients were followed up, and AOP was measured in them using transperineal ultrasound. Patients were divided into two groups according to mode of delivery as follows: group 1, delivered by CS, and group 2, delivered by normal vaginal delivery (NVD). Results The mean AOP was decreased in CS group (98.20 ± 15.83) than NVD group (112.21 ± 12.66). Additionally, at cutoff point of AOP less than 95 (86°), area under curve was 0.511 (95% confidence interval: 0.264–0.758; P = 0.024), with sensitivity of 71.4%, specificity of 85.5%, and accuracy 81.5%. However, at cutoff point of AOP more than 95 (113°), area under curve was 0.545 (95% confidence interval: 0.412–0.679; P = 0.016), with sensitivity of 85.7%, specificity of 69.4%, and accuracy 93.25%. Conclusions The AOP was significantly decreased in CS group than NVD group. The results prove a vital role for using this angle as a simple and accurate landmark to evaluate station of fetal head and provide a useful predictor for mode of delivery, particularly in patients with planned vaginal birth after cesarean delivery (VBAC).

Relation of meconium-stained amniotic fluid and postpartum hemorrhage: a retrospective cohort study.

Postpartum hemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. The purpose of this study was to evaluate if meconium-stained amniotic fluid (MSAF) is a risk factor for PPH after vaginal delivery. We retrospectively analyzed medical records of all patients who had a vaginal delivery at Fujian Provincial Maternity and Children's Hospital, between 1st January 2013 to 31st December 2018. Women with cesarean deliveries, multiple pregnancies, abnormal coagulation profile, and those with concomitant liver or kidney disorders were excluded. Patients were classified into MSAF (n=13686) and clear amniotic fluid (AF) (n=41511) groups. The incidence of PPH was significantly higher at 2.7% (370/13686) in the MSAF group as compared to 2.18% (904/41511) in the clear AF group (p=0.0004). There was no difference in the incidence of severe PPH between the two groups. Statistically significant difference in the incidence of PPH between MSAF and clear AF was seen in the maternal age groups of 30-34 and 35-39 years, gestational age>40weeks and >3 gravidity (p<0.05). Our study demonstrates that MSAF is a significant risk factor for minor and moderate PPH. Presence of meconium could therefore alert clinicians to expect PPH and make arrangements for further patient management. Further basic research is required to evaluate the mechanism by which meconium influences the incidence of PPH.

Eating a tiny bit of mom’s poop could give C-section babies an immune ‘primer’

Eating a tiny bit of mom’s poop could give C-section babies an immune ‘primer’

Does Negative Pressure Wound Dressing Improve Healing in Obese Women After Cesarean Delivery

Women with body-mass index ≥30 kg/m2 are at greater risk for major postoperative wound complications. Investigators compared two approaches to wound

A MODERN VIEW OF THE OF THE CAESAREAN SECTION (REVIEW)

The problem of caesarean section has medical and economic aspects, is relevant and widely discussed in the literature. In the modern world, caesarean section in frequency of execution surpasse all other abdominal operations. The review considers the reasons for the increase in the frequency of caesarean section and the possibility of reducing these indicators. The methods of anesthesia during caesarean section, the moments of pharmaceutical perioperative support, issues of complications in the postoperative period are described. Examples of successful abdominal delivery with a combined other pathology are given.

Клініко-статистичний аналіз акушерських і перинатальних ускладнень при одноплідній та багатоплідній вагітності після застосування допоміжних репродуктивних технологій

The objective: conduct a comparative clinical and statistical analysis of obstetric and perinatal complications in singleton and multiple pregnancies after assisted reproductive technologies (ART) according to archival documents (pregnancy observation data and birth history) and identify features of multiple pregnancy. Materials and methods. During the period 2017–2019, 522 women gave birth in maternity hospital «Leleka» after assisted reproductive technologies, 331 women were observed in the maternity hospital «Leleka». 445 women gave birth with a singleton pregnancy and 77 with a multiple pregnancy. A clinical and statistical analysis of 150 pregnancy and childbirth histories was performed. All pregnant women were divided into two groups: Group I – 75 pregnant women with singleton pregnancies after ART; Group II – 75 pregnant women with multiple pregnancies after ART. The selection criteria for comparative clinical and statistical analysis were women whose pregnancies occurred as a result of ART, namely by in vitro fertilization (IVF) using five-day frozen embryos. Mathematical research methods were performed in accordance with the recommendations of O.P. Minzer (2013). The reliability of the cancellation of the mean pairs was calculated using the Student’s and Fisher’s criteria. Graphs were designed using the program «Microsoft Excel». Results. Complications of early pregnancy in multiple pregnancies were: anemia (47.8% vs. 22.9%; p&lt;0.01), placental dysfunction (43.3% vs. 22.9%; p&lt;0.01), the threat of abortion (41.8% vs. 28.6%; p&lt;0.01). Complications of the second half of pregnancy: preeclampsia (52.7% vs. 20.6%; p&lt;0.01), fetal growth retardation (20.0% vs. 7.4%; p&lt;0.01), gestational anemia (76,4% vs. 32.4%; p&lt;0.01), placental dysfunction (47.3% vs. 22.1%; p&lt;0.05). Complications in childbirth in women with multiple pregnancies were as follows: premature rupture of membranes (30.9% vs. 10.3%; p&lt;0.05), anomalies of labor activity (16.4% vs. 5.9%; p&gt;0.05), fetal distress (29.1% vs. 14.7%; p&lt;0.05), premature placental abruption (3.6% vs. the absence of this indicator in group I). In patients of group II with multiple pregnancies 3.7 times more often the pregnancy ended prematurely compared with singleton (21.8% vs. 5.9%; p&lt;0.05). Early preterm births predominated, of which births occurred in 3.6% of cases at 22–28 weeks, 7.3% at 28–32 weeks, and 6.4% at 32–34 weeks. Significant increase in the frequency of 32.7% of abdominal births in multiple pregnancies against 11.8% of patients in pregnancy with a single fetus (p&lt;0.01). The structure of indications in patients of group II was as follows: severe preeclampsia 27.8%, development of fetal growth retardation and fetal distress of 11.1%, respectively, premature placental abruption 16.7%, the following single indications (pelvic presentation of the fetus, transverse or oblique position of the fetus, clinically narrow pelvis, abnormalities of labor, scar on the uterus) – 33.3%. Significant increase in the total frequency of neonatal asphyxia of varying severity in multiple pregnancies (35.0% vs. 5.9%; p&lt;0.05), fetal growth retardation (27.3% vs. 11.8%; p&lt;0.01). Conclusions. Multiple pregnancies are a high risk factor for gestational anemia, preeclampsia, placental dysfunction, early fetal growth retardation, and fetal distress during pregnancy and childbirth. This causes a high level of abdominal delivery. Therefore, further research to predict and prevent obstetric and perinatal complications in multiple pregnancies after ART is relevant today. Keywords: obstetric and perinatal complications of pregnancy, multiple pregnancy, assisted reproductive technologies.

Improving Perioperative Outcomes After Cesarean Delivery — New ERAS Ahead?

The enhanced recovery after surgery (ERAS) model, which reduces surgical stress by optimizing perioperative patient care provided by multidisciplinary

Isolated Bladder Endometriosis in a Patient With Previous Cesarean Sections

Urological endometriosis is rare and accounts for approximately 1% of women with endometriosis. The pathophysiology of bladder endometriosis may be divided into two different causes, namely primary and secondary. The primary form occurs spontaneously and manifests in a form of a generalized pelvic disease whereas the secondary form is thought to be iatrogenic and typically occurs after pelvic surgery such as Cesarean section or hysterectomy. We present a case report on a patient presenting with an invasive bladder mass initially thought to be from a pelvic malignancy. The final histology showed isolated bladder endometriosis. She had a significant past medical history of two previous Cesarean sections. A review of her magnetic resonance imaging (MRI) images demonstrated the presence of a Cesarean scar niche which may be linked to her bladder endometriosis. There is a need to improve awareness of the possible link between Cesarean scar niche with bladder endometriosis. This is important as it raises the clinical question of whether appropriate repair of Cesarean scar niches can prevent future complications such as bladder endometriosis which can potentially be associated with significant morbidity. J Med Cases. 2020;11(11):370-373 doi: https://doi.org/10.14740/jmc3543

Fatores associados à prevalência do aleitamento materno exclusivo ao neonato de baixo peso: revisão integrativa

Objetivo: Relatar os fatores associados à prevalência do aleitamento materno exclusivo ao neonato de baixo peso. Método: Trata-se de uma revisão integrativa, utilizando periódicos nas bases de dados: BVS e Scielo. Primeiro elaborou-se a pergunta norteadora “Quais fatores estão associados à prevalência do aleitamento materno exclusivo ao neonato de baixo peso?”; seguido pela busca na literatura, coleta de dados, análise crítica dos estudos incluídos, discussão dos resultados e por fim apresentação da revisão integrativa. Foram estabelecidos como critérios de inclusão artigos originais e completos nos últimos cinco anos. Excluindo teses e dissertações, textos incompletos, artigos editoriais, resumos, ou publicações fora do período estabelecido. Resultados e discussão: Foi possível verificar que apesar das diversas estratégias de incentivo a amamentação exclusiva para recém-nascidos de baixo peso, como por exemplo, Banco de Leite Humano, Hospital Amigo da Criança e método canguru, muitos estudos mostram que ainda existe alto percentual de desmame precoce no Brasil, mesmo em neonatos de baixo peso. Alguns fatores associados a isso são a idade materna, volta ao mercado de trabalho pela mãe, parto cesariano, uso de chupetas e outros líquidos antes dos seis meses de idade. Conclusão: O Aleitamento materno exclusivo se mostra fundamental para melhoria das condições de saúde do recém-nascido. Fatores que vão desde o tipo de parto ao incentivo pela equipe de saúde podem contribuir para a manutenção desse aleitamento. Destaca-se a importância de maiores estudos acerca dos métodos efetivos de incentivo e principais motivos que levam ao desmame precoce.

Applying the Robson classification to routine facility data to understand the Caesarean section practice in conflict settings of South Kivu, eastern DR Congo.

IntroductionSub-Saharan Africa has low Caesarean (CS) levels, despite a global increase in CS use. In conflict settings, the pattern of CS use is unclear because of scanty data. We aimed to examine the opportunity of using routine facility data to describe the CS use in conflict settings.MethodsWe conducted a facility-based cross-sectional study in 8 health zones (HZ) of South Kivu province in eastern DR Congo. We reviewed patient hospital records, maternity registers and operative protocol books, from January to December 2018. Data on direct conflict fatalities were obtained from the Uppsala Conflict Data Program. Based on conflict intensity and chronicity (expressed as a 6-year cumulative conflict death rate), HZ were classified as unstable (higher conflict death rate), intermediate and stable (lower conflict death rate). To describe the Caesarean section practice, we used the Robson classification system. Based on parity, history of previous CS, onset of labour, foetal lie and presentation, number of neonates and gestational age, the Robson classification categorises deliveries into 10 mutually exclusive groups. We performed a descriptive analysis of the relative contribution of each Robson group to the overall CS rate in the conflict stratum.ResultsAmong the 29,600 deliveries reported by health facilities, 5,520 (18.6%) were by CS; 5,325 (96.5%) records were reviewed, of which 2,883 (54.1%) could be classified. The overall estimated population CS rate was 6.9%. The proportion of health facility deliveries that occurred in secondary hospitals was much smaller in unstable health zones (22.4%) than in intermediate (40.25) or stable health zones (43.0%). Robson groups 5 (previous CS, single cephalic, ≥ 37 weeks), 1 (nulliparous, single cephalic, ≥ 37 weeks, spontaneous labour) and 3 (multiparous, no previous CS, single cephalic, ≥ 37 weeks, spontaneous labour) were the leading contributors to the overall CS rate; and represented 75% of all CS deliveries. In unstable zones, previous CS (27.1%) and abnormal position of the fetus (breech, transverse lie, 3.3%) were much less frequent than in unstable and intermediate (44.3% and 6.0% respectively) and stable (46.7%and 6.2% respectively). Premature delivery and multiple pregnancy were more prominent Robson groups in unstable zones.ConclusionIn South Kivu province, conflict exposure is linked with an uneven estimated CS rate at HZ level with at high-risks women in conflict affected settings likely to have lower access to CS compared to low-risk mothers in stable health zones.

Defining arrest in the 1st and 2nd stages of labor

Normal labor is identified as regular uterine contractions in addition to dilation and effacement of the cervix. It is necessary to define normal labor in order to delineate when a woman's labor pattern diverges from that observed in most women. Labor irregularities are subdivided into protraction disorders and arrest disorders. Identifying abnormal labor patterns and initiating appropriate interventions are essential because prolonged labor is associated with an increase in perinatal morbidity. The objective of this review is to delineate both normal labor progress and also discuss the current evidence-based diagnosis and treatment of protraction and arrest disorders. Many subtleties go into defining the boundaries of the first and second stages of labor. Historically, the Friedman curve established normal limits, but currently, Zhang has advanced these definitions by accounting for current demographical characteristics and practice environments. The most significant variables for defining normal progress of labor are parity and regional anesthesia status. The most common causes of labor abnormalities are uterine inactivity, obesity, cephalopelvic disproportion and fetal malposition. Risks of extending the first and/or second stage of labor include postpartum hemorrhage, intraamniotic infection and potentially an increase in neonatal adverse outcomes. The management of labor disorders consists of oxytocin administration, amniotomy, intrauterine pressure catheter use and shared decisionmaking regarding proceeding with expectant management, operative vaginal delivery or cesarean delivery after weighing the risks and benefits of each option. The decision to extend the duration of labor is personalized for each mother-baby dyad and should be agreed upon depending on individual maternal and fetal circumstances.

Expectativas e sentimentos das puérperas acerca do trabalho de parto e parto

Objetivo: compreender as expectativas que as puérperas têm em relação ao trabalho de parto e parto e, quais os sentimentos que o período periparto despertou nessas mulheres. Metodologia: estudo qualitativo, realizado em um hospital de ensino do sul do Brasil, cujos critérios de inclusão foram: puérperas que tiveram gestação de baixo risco e que passaram por trabalho de parto e parto vaginal. E, os critérios de exclusão: mulheres que, durante o trabalho de parto tiveram intercorrências, cesárea indicada durante ou, após o parto, não estavam com seus bebês. A coleta dos dados ocorreu por meio da entrevista semiestruturada e analisados através da Análise de Conteúdo. Resultados: Posterior a análise, emergiu uma categoria: Percepção das puérperas acerca do trabalho de parto e parto, a qual foi distribuída em duas subcategorias: Expectativas acerca do trabalho de parto e parto e, sentimentos relacionados ao trabalho de parto e parto. Foi possível perceber o despreparo e a falta de conhecimento das mulheres sobre o processo de nascimento, relatos de expectativas positivas, porém superficiais e sentimentos negativos, como sofrimento, medo, dor, ansiedade demonstrando importante falha na assistência pré-natal. Conclusão: Conclui-se que há desinformação entre as mulheres sobre a complexidade do parir, o que lhes retira o poder de decisão e autonomia sobre o parto.

Взгляд на проблему миомэктомии при беременности и во время кесарева сечения

Взгляд на проблему миомэктомии при беременности и во время кесарева сечения

Cesarean section in the perinatal center of iii level - indications and risk factors

In the structure of labour, the frequency of caesarean section should not exceed 15%. Therefore, it is extremely important to clearly define clinical situations in which caesarean section can be abandoned and, conversely, identify pregnant women in whom it is advisable to plan a caesarean section to prevent urgent situations.The aim of the study was to study the structure of indications for emergency abdominal delivery in a level III medical department - the urban perinatal center of Kharkov to optimize childbirth tactics.Material and methods. Clinical and statistical analysis of pregnancy and childbirth histories of 550 women in labour who gave birth in the Kharkov city perinatal center during 2018-2019 was performed. The structure of the indications and the caesarean section frequency was analysed depending on clinical and anamnestic data using descriptive statistics methods, χ2 criterion and calculation of the odds ratio (OR) using the PSSР statistical software package.Results. The highest OR values were in diabetes mellitus, burdened gynecological history and cardiovascular diseases (OR more than 5.0). Gestational hypertension, first labour, genital tract infections, nervous system diseases, preeclampsia, obesity of the digestive system diseases, large fetus and vegetative-vascular dystonia (OR from 2.108 to 4.113) had a lesser effect, myopia, first pregnancy, and late reproductive age (OR from 1.619 to 1.958).Conclusion. The most common causes of emergency caesarean section were weak labour (29.5%) and fetal distress (13.2%). In 20.9% of women - concomitant diseases of the mother and large fetus. Indications for emergency caesarean section most often occurred in women in labour with diabetes mellitus, weighed down by a gynecological history and with cardiovascular diseases