Classical Cesarean Research Articles

Evaluation of Classical Cesarean Delivery Outcomes [20K

INTRODUCTION: To compare maternal outcomes for classical cesarean delivery (CCD) with low transverse cesarean delivery (LTCD) early preterm. METHODS: We conducted a multi-hospital retrospective cohort study of women undergoing cesarean delivery (CD) at 23–31 weeks between 2005 and 2014. Intraoperative outcomes (incision-delivery time [ID-time], total operative time [TO-time], and estimated blood loss [EBL]) and composite maternal outcome (postpartum hemorrhage, transfusion, endometritis, sepsis, wound infection, deep venous thrombosis/pulmonary embolism, hysterectomy, pulmonary edema, and intensive care unit [ICU] admission) were compared between CCD and LTCD. Outcomes were calculated using multivariable logistic regression models yielding adjusted odds ratios (aOR) with 95% CI and adjusted P values controlling for maternal characteristics, emergency CD, and comorbidities. Analyses were stratified by gestational age (GA) groups (23–27 and 28–31 weeks) as well as primary versus repeat CD. RESULTS: Of 902 women meeting inclusion criteria, 221 (64%) and 82 (16%) underwent CCD at 23–27 and 28–31 weeks, respectively. For primacy CDs, no difference was seen in ID-times regardless of GA. For repeat CDs, CCD was associated with longer ID-times regardless of GA (P<.05 for all). Primary and repeat CCD were associated with longer TO-times regardless of GA (P<.01 for all). At 28–31 weeks, CCD was associated with increased risk of transfusion (aOR=3.06; 95% CI=1.39–6.75), ICU admission (aOR=5.42; 95% CI=1.39–21.06), and composite maternal outcome (aOR=2.23; 95% CI=1.27–3.91); no increased risk was seen for CCD at 23–27 weeks. CONCLUSION: CCD at 28–31 weeks was associated with increased maternal complications. CCD did not enhance faster ID-time and therefore CCD solely for facilitating more rapid delivery is not indicated.

Serious maternal complications after early preterm delivery (24-33 weeks’ gestation)

We sought to describe the prevalence of serious maternal complications following early preterm birth by gestational age (GA), delivery route, and type of cesarean incision. Trained personnel abstracted data from maternal and neonatal charts for all deliveries on randomly selected days representing one third of deliveries across 25 US hospitals over 3 years (n = 115,502). All women delivering nonanomalous singletons between 23-33 weeks' gestation were included. Women were excluded for antepartum stillbirth and highly morbid conditions for which route of delivery would not likely impact morbidity including nonreassuring fetal status, cord prolapse, placenta previa, placenta accreta, placental abruption, and severe and unstable maternal conditions (cardiopulmonary collapse, acute respiratory distress syndrome, seizures). Serious maternal complications were defined as: hemorrhage (blood loss ≥1500 mL, blood transfusion, or hysterectomy for hemorrhage), infection (endometritis, wound dehiscence, or wound infection requiring antibiotics, reopening, or unexpected procedure), intensive care unit admission, or death. Delivery route was categorized as classic cesarean delivery (CCD), low transverse cesarean delivery (LTCD), low vertical cesarean delivery (LVCD), and vaginal delivery. Association of delivery route with complications was estimated using multivariable regression models yielding adjusted relative risks (aRR) controlling for maternal age, race, body mass index, hypertension, diabetes, preterm premature rupture of membranes, preterm labor, GA, and hospital of delivery. Of 2659 women who met criteria for inclusion in this analysis, 8.6% of women experienced serious maternal complications. Complications were associated with GA and were highest between 23-27 weeks of gestation. The frequency of complications was associated with delivery route; compared with 3.5% of vaginal delivery, 23.0% of CCD (aRR, 3.54; 95% confidence interval (CI), 2.29-5.48), 12.1% of LTCD (aRR, 2.59; 95% CI, 1.77-3.77), and 10.3% of LVCD (aRR, 2.27; 95% CI, 0.68-7.55) experienced complications. There was no significant difference in complication rates between CCD and LTCD (aRR, 1.37; 95% CI, 0.95-1.97) or between CCD and LVCD (aRR, 1.56; 95% CI, 0.48-5.07). The risk of maternal complications after early preterm delivery is substantial, particularly in women who undergo cesarean delivery. Obstetricians need to be prepared to manage potential hemorrhage, infection, and intensive care unit admission for early preterm births requiring cesarean delivery.

Cesarean Section: One of the Oldest and Controversial Surgical Procedures

The idea of the possibility of childbirth in another route than natural still exists from mythology. The name derives from the Latin “caedere” – cut, sever. For many centuries, ever since the Roman Empire, the operation was performed only rarely and women who died in childbirth. Indications that cesarean would be performed even women are living since 1040 in Rabbi Gershon to Metz, Talmud's comment. In 1581 the first paper appears in France dedicated caesarean women live, but the first successful Caesarean operation are reported in France, only in 1689 from surgeon Jean Rulau, in Ireland 1748 from midwife Marie Donaly and in 1794 in Virginia (USA) from the country doctor Jesse Bennett. Mortality after cesarean on women living it was still very high. A significant decrease occurred in the 19th century it when decline spectacular after improvements are made of the operation. Mainly this is due to Frank E. Polin in US, Alfred Kehrer in Heidelberg, Max Sanger in Leipzig and Eduardo Porro in Milan. Their refinements of the technique were essential cesarean bringing a lot of one that is currently running. Classical caesarean is practiced today after Stark technique, method Joel Cohen. After a long and controversial trend for nearly two millennia, marked for centuries by almost prohibitive mortality, the current cesarean operation is a great success in perseverance deeply humanitarian attempts to save two lives, a mother and child.

400: Postpartum complications in women with early preterm delivery (ePTD)

To describe the prevalence of serious maternal morbidity (MM) following ePTD (23 - 33 weeks) by gestational age (GA) and to determine if MM varies by delivery route by comparing classical cesarean delivery (CCD) and low transverse cesarean delivery (LTCD) with vaginal delivery (VD).

138: Subsequent maternal pregnancy outcomes after prior preterm classical vs prior term classical cesarean

138: Subsequent maternal pregnancy outcomes after prior preterm classical vs prior term classical cesarean

Outcomes of expectantly managed pregnancies with multiple gestations and preterm premature rupture of membranes prior to 26 weeks

The objective of the study was to determine the obstetric and neonatal outcomes of expectantly managed multifetal pregnancies complicated by early preterm premature rupture of membranes (PPROM) prior to 26 weeks. This was a retrospective cohort of all multifetal pregnancies complicated by documented PPROM occurring before 26 0/7 weeks and managed expectantly by a single maternal-fetal medicine practice between July 4, 2002, and Sept. 1, 2013. Neonatal and maternal outcomes were assessed and comparisons made between the fetus with ruptured membranes and the first fetus to deliver with intact membranes. Twenty-three pregnancies (46 fetuses) were analyzed with a median gestational age at PPROM of 22.9 weeks; 74% experienced PPROM at less than 24 weeks' gestation. A median latency of 11 days was achieved with expectant management. Of the 46 neonates, 20 (43%) survived to hospital discharge. Of these, 12 (60%) experienced severe neonatal morbidity defined as defined as grade III or IV intraventricular hemorrhage, bronchopulmonary dysplasia, pulmonary hypoplasia, necrotizing enterocolitis requiring surgical intervention, and/or grade 3 or 4 retinopathy of prematurity. Eight neonates survived to hospital discharge without severe neonatal morbidity. The multiple with ruptured membranes was more likely to experience intrauterine demise but otherwise had similar outcomes as the multiple with intact membranes. Maternal morbidity was considerable, with 7 of 23 pregnancies (30%) complicated by clinical chorioamnionitis, 12 of 23 (52%) delivering by cesarean, of which 3 of 12 (25%) were classical cesarean deliveries. Overall, neonatal survival to hospital discharge was 43%, but only 17% survived without significant neonatal morbidity. These data provide a basis for counseling and management of women with multifetal gestation complicated by very early PPROM.

Amniotic fluid embolism: antepartum, intrapartum and demographic factors

Objective: To describe the incidence, antepartum, intrapartum and postpartum risk factors, and mortality rate of amniotic fluid embolism (AFE).Methods: We used 2001–2007 California health discharge data to identify cases of AFE by ICD-9 codes.Results: Of 3 556 567 deliveries during the time period, we identified 182 cases of AFE, resulting in a population incidence of 5.1 in 100 000. Twenty-four of the cases resulted in death, giving a case fatality rate of 13.2%. Non-Hispanic blacks had a higher than 2-fold odds of developing AFE. AFE increased significantly with maternal age, most significantly after age 39. Cardiac disease had a nearly 70-fold higher association with AFE, cerebrovascular disorders had a 25-fold higher association, while conditions such as eclampsia, renal disease, placenta previa and polyhydramnios had nearly 7- to 13-fold higher associations. Classical cesarean delivery, abruption placentae, dilation and curettage, and amnioinfusion were all procedures highly associated with AFE.Conclusion: Several antepartum and peripartum conditions and procedures are associated with significantly higher risks of amniotic fluid embolism. This information may contribute to a better understanding of the pathophysiology of AFE and potentially help identify those at the highest risk of developing this morbid condition.

389: Timing of delivery in women with history of classical cesarean: a decision analysis

389: Timing of delivery in women with history of classical cesarean: a decision analysis

Uterocutaneous fistula following classical caesarean delivery for placenta percreta with intentional retention of the placenta

Uterocutaneous fistula is a rare complication following caesarean delivery in the immediate postpartum period. There are few cases of uterocutaneous fistulae that have been reported in the literatu...

PP.91 Rupture Uterus Following Previous Caesarean Section in the Second and Early Third Trimester of Subsequent Pregnancy

Three cases of antenatal/pre-labour uterine rupture in women with scarred uterus.Rupture uterus following lower segment caesarean section is rare occurrence.Rupture uterus is linked with abnormal implantation of the placenta, and...

PF.74 Conjoined Twins: A 10 Year Experience in a Tertiary Centre

The incidence of conjoined twins (CT) is reported to be in the range of 1–2 in 100000 pregnancies. Ireland has the highest rate of live birth CT in Europe.1We discuss...

Placenta membranacea

Placenta membranacea is a rare placental disorder characterized by the presence of fetal membranes (complete or partially) covered by chorionic villi. A 35-year-old woman, gravida 1, was admitted for preterm labor at 24 weeks and 5 days. She subsequently developed heavy vaginal bleeding and underwent a classical cesarean delivery for suspected abruption. Postpartum inspection of the placenta demonstrated a small placenta with tan colored membranes, and diffusely scattered placental cotyledons. Histologic examination revealed chorionic villi directly attached to the fetal membranes on the periphery,consistent with the diagnosis of a partial placenta membranacea. Placenta membranacea should be considered in the etiology of painless vaginal bleeding in the second and third trimester. This condition can be associated with other placental abnormalities, such as placenta previa or accreta. Perinatal outcome may include stillbirth, preterm delivery, or neonatal death.

Risk of Uterine Rupture and Placenta Accreta With Prior Uterine Surgery Outside of the Lower Segment

Women with a prior myomectomy or prior classical cesarean delivery often have early delivery by cesarean because of concern for uterine rupture. Although theoretically at increased risk for placenta accreta, this risk has not been well-quantified. Our objective was to estimate and compare the risks of uterine rupture and placenta accreta in women with prior uterine surgery. Women with prior myomectomy or prior classical cesarean delivery were compared with women with a prior low-segment transverse cesarean delivery to estimate rates of both uterine rupture and placenta accreta. One hundred seventy-six women with a prior myomectomy, 455 with a prior classical cesarean delivery, and 13,273 women with a prior low-segment transverse cesarean delivery were evaluated. Mean gestational age at delivery differed by group (P<.001), prior myomectomy (37.3 weeks), prior classical cesarean delivery (35.8 weeks), and low-segment transverse cesarean delivery (38.6 weeks). The frequency of uterine rupture in the prior myomectomy group (P-MMX group) was 0% (95% confidence interval [CI] 0-1.98%). The frequency of uterine rupture in the low-segment transverse cesarean delivery group (LTC group) (0.41%) was not statistically different from the risk in the P-MMX group (P>.99) or in the prior classical cesarean delivery group (PC group) (0.88%; P=.13). Placenta accreta occurred in 0% (95% CI 0-1.98%) of the P-MMX group compared with 0.19% in the LTC group (P>.99) and 0.88% in the PC group (P=.01 relative to the LTC group). The adjusted odds ratio for the PC group (relative to LTC group) was 3.23 (95% CI 1.11-9.39) for uterine rupture and 2.09 (95% CI 0.69-6.33) for accreta. The frequency of accreta for those with previa was 11.1% for the PC group and 13.6% for the LTC group (P>.99). A prior myomectomy is not associated with higher risks of either uterine rupture or placenta accreta. The absolute risks of uterine rupture and accreta after prior myomectomy are low.

W175 PREGNANCY OUTCOMES IN WOMEN WITH A PRIOR CLASSICAL CESAREAN DELIVERY: A FIVE YEAR OBSERVATION AT A TERTIARY CARE CENTER

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S761-S761 Poster presentations W175 PREGNANCY OUTCOMES IN WOMEN WITH A PRIOR CLASSICAL CESAREAN DELIVERY: A FIVE YEAR OBSERVATION AT A TERTIARY CARE CENTER R. Malapati, R. MalapatiSearch for more papers by this authorS. Panesar, S. PanesarSearch for more papers by this authorT.M. Nguyen, T.M. NguyenSearch for more papers by this author R. Malapati, R. MalapatiSearch for more papers by this authorS. Panesar, S. PanesarSearch for more papers by this authorT.M. Nguyen, T.M. NguyenSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)61900-6AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S761-S761 RelatedInformation

Uterine fibroids: from pregnancy to neonatal outcomes

To study the effects of uterine fibroids on obstetrical and neonatal outcomes. A retrospective cohort analysis. All department ultrasounds from 1998 to 2006 were reviewed. All patients diagnosed with fibroids at initial obstetrical ultrasound were included to total 152. A control group was extracted from the same database, in a 1:1 ratio. The following parameters were paired for the fibroid and control group: age, gravidity, parity and year of delivery. Obstetrical and neonatal outcomes were compared in the two groups using the Fisher's Exact and Pearson's Chi-square test for categorical variables and Mann-Whitney U test for non-normally distributed measures. A total of 317 pregnancies were included in the analysis, of which 152 women had uterine fibroids and 165 did not. Demographics were comparable in the two groups except the African American race which was significantly higher in the fibroid group (90.8 vs. 68.5%, P<.001). Co-morbidities were comparable, except chronic hypertension (13.8 vs. 6.7, P=.040). Fibroid degeneration occurred in 23% of the pregnancies. (Table1) compares the obstetrical and neonatal outcomes.Tabled 1Obstetrical and Neonatal outcomesOutcomeFibroidControlp valueFirst trimester loss (%)7.93.6.143Second trimester loss (%)5.91.2.029Preterm labor (%)16.42.4<.001PPROM∗Premature preterm rupture of membranes. (%)15.83.6<.001IUGRIntrauterine growth restriction (%)15.18.5.08Malpresentation (%)22.06.0<.001Cesarean (%)54.328.0<.001Low transverse Cesarean (%)74.795.3.005Classical cesarean (%)17.34.7.08Pre-eclampsia (%)11.83.1.003Estimated blood loss (cc)732.7 ± 578.93466.1 ± 366.04<.001Birth weight (grams)2634.8 ± 1052.463181.4 ± 628.15<.001Apgars at 1 and 5 minutes6.7 & 7.97.8 & 8.8<.001Gestational age at delivery (weeks)35.3 ± 6.738.6 ± 2.8<.001Delivery before 37 weeks (%)10.133.3<.001∗ Premature preterm rupture of membranes.∗∗ Intrauterine growth restriction Open table in a new tab Uterine fibroids complicate the pregnancy course as evidenced by a considerable impact on obstetrical and neonatal outcomes.

Gravid hysterectomy following history of recurrent ruptured uterus: Case report

The risk of uterine rupture and its associated morbidities increases as the incidence of cesarean deliveries increases. There is little evidence guiding the management of pregnancy termination in patients with a history of uterine rupture. A 21-year-old woman with a history of a classical cesarean delivery and four subsequent uterine ruptures presented for termination of pregnancy at 17 weeks and 2 days. Ultrasound study noted anterior wall implantation of the placenta covering the classical cesarean scar as well as the subsequent cesarean section scars. A scheduled gravid hysterectomy was performed to complete the pregnancy termination and avoid recurrent uterine rupture. Pathological examination revealed marked attenuation and fibrosis of the anterior uterine wall with diffuse placenta accreta and focal placenta percreta justifying the decision for hysterectomy in this young patient. We therefore suggest that gravid hysterectomy rather than dilatation and evacuation should be considered for pregnancy termination in patients with history of recurrent uterine rupture and suspicion for abnormal placentation.

669: Classical cesarean delivery between 23-27 weeks gestation: immediate complications and effects on subsequent pregnancy

669: Classical cesarean delivery between 23-27 weeks gestation: immediate complications and effects on subsequent pregnancy

559: Risk of classical cesarean delivery associated with aggressive obstetrical interventions in pregnancies at 23-27 weeks

Decision-making regarding the level of obstetrical care at early gestational age (GA) periods is often focused on neonatal rather than maternal benefits and risks. When cesarean delivery (CD) is performed at these GA ranges, classical CD is much more common. Classical CD is associated with greater short-term maternal morbidity and requirement for repeat CD in future pregnancies. The purpose of this study was to determine the probability of classical CD for women who deliver at early GA ranges following aggressive obstetrical management.

Misoprostol for second trimester pregnancy termination in women with prior caesarean: a systematic review

Second trimester pregnancy induction with misoprostol in women with prior caesarean delivery is not well studied. To estimate the risk of uterine rupture using misoprostol as an induction agent for pregnancy termination in the second trimester of pregnancy in women with prior caesarean delivery. Cases of women with a history of prior caesarean delivery and subsequent misoprostol induction for pregnancy termination in the second trimester (16-28 weeks) were obtained from two main data sources. First, a retrospective chart analysis was performed at Thomas Jefferson University Hospital and Christiana Hospital between 1998 and 2004. Second, multiple Medline, Scopus and POPLINE literature searches were performed. Case series and cohort studies of women with one or more prior caesarean delivery (of any type), and with a subsequent pregnancy with induction of labour for pregnancy termination at 16-28 weeks using misoprostol as the initial primary agent were included. Case reports were analysed separately. Total cases were analysed by type and number of prior caesarean delivery, for the primary outcome of uterine rupture. The incidence of uterine rupture associated with second trimester misoprostol termination was 0.4% (2/461) in women with one prior low transverse, 0% (0/46) in those with two prior low transverse and 50% (1/2) in those with a prior classical caesarean delivery. One of the cases of uterine rupture in a woman with a prior low transverse caesarean required transfusion. None of the total eight cases (including case reports) of uterine rupture was associated with hysterectomy. Second trimester misoprostol termination appears safe among women with one prior low transverse caesarean birth, as it is associated with incidences of uterine rupture of 0.4% (95% confidence interval 0.08-1.67%), of hysterectomy of 0% and of transfusion of 0.2%. There are insufficient data on risk with more than one prior caesarean birth or with prior classical caesarean birth.

Vaginal Birth after Classical Caesarean Section

Vaginal Birth after Classical Caesarean Section