Complication Of Cesarean Section Research Articles

A rare acute complication of caesarean section: Preperitoneal incisional hernia.

A rare acute complication of caesarean section: Preperitoneal incisional hernia.

Ultrasound guided vacuum aspiration treatment of caesarean scar ectopic pregnancy

To describe the case of ectopic pregnancy in the scar after caesarean section and its successful treatment using the technique of sonographically controlled vacuum aspiration. The case of a 35-year-old patient with a history of two caesarean sections referred by a district gynecologist in the 6th week of pregnancy with suspected pathological localization of pregnancy in a scar after a previous caesarean section. The procedure for the diagnosis and treatment of ectopic pregnancy in the scar after previous caesarean sections has been successfully resolved using sonographically controlled vaginal vacuum aspiration. Caesarean scar pregnancy occurs as a complication of previous caesarean section or other uterine instrumental performances. The use of the sonographically controlled vacuum aspiration technique appears to be a successful method of treating pregnancy in a scar after a caesarean section.

Multidetector Computed Tomography Evaluation of Uncommon Acute Post-Caesarean Section Complications

Introduction. The most common major abdominal surgery in women is caesarean section. Despite being a safe procedure, a variety of complications, both acute and chronic, can occur. About 14.5% of caesarean sections result in complications. Infection followed by postpartum haemorrhage is the most frequent complication. Imaging modalities such as ultrasonography and multidetector computed tomography are often used in the evaluation of suspected uncommon post-caesarean complications. Computed tomography has been found to be a good initial modality for assessing acute postoperative complications after caesarean delivery.
 The objective of the research was to evaluate the imaging findings and the characteristic visual manifestations of atypical acute complications of caesarean section, other than common complications such as postpartum haemorrhage, wound infection, etc.
 Materials and Methods. This prospective study was carried out at the Department of Radiodiagnosis and Imaging, Government Medical College, Srinagar from June 2019 to February 2020 in collaboration with the Department of General Surgery and Gynaecology and Obstetrics of the Sher-i-Kashmir Institute of Medical Sciences. All patients with suspected complication in the immediate post-caesarean period were evaluated with contrast-enhanced multidetector computed tomography.
 Results. Out of 427 patients who underwent caesarean section, 25 patients were suspected of having uncommon acute complications. Out of 25 patients evaluated for suspected immediate post-caesarean complication, only 5 patients had bladder flap hematoma, 8 patients were diagnosed with uterine dehiscence, 6 patients had uterine rupture, 3 patients suffered from ureteral injury, 1 patient had gossypiboma, 2 patients developed pelvic sepsis.
 Conclusions. Multidetector computed tomography plays an important role in detection and confirmation of multiple acute complications after caesarean delivery and can also help in guiding the management of complications as well.

CAUSE DHEMORRAGIE POST PARTUM A LAQUELLE IL FAUT PENSER: PSEUDO-ANEVRISME DE LARTERE UTERINE APRES UNE CESARIENNE, A PROPOS DUN CAS

Pseudoaneurysm of the uterine artery is a rare and poorly understood complication of Caesarean section or endocavitary manipulation. It can be responsible for severe postpartum hemorrhage, most often secondary or retarded. We present here a case of pseudoaneurysm of the left uterine artery diagnosed and treated in the gynecological-obstetrics department I, CHU HASSAN II DE FES. The diagnosis was guided by ultrasound but uterine arteriography of the uterine arteries remains a determining factor in establishing and making the diagnosis and also guiding the treatment.Selective arterial embolization was the treatment of choice. It has excluded the lesion, but vascular ligature or hysterectomy may be necessary if the patient is hemodynamically unstable.

Caesarean Section in a Tertiary Hospital in South-South, Nigeria: A 3-year Review

Background: Caesarean section is the delivery of the foetus, placenta, and foetal membranes through an incision on the abdominal and uterine walls after the age of foetal viability. It is a life-saving surgical procedure, which has helped reduce maternal and perinatal morbidity and mortality over the years.
 Objective: To determine the rates, indications, outcomes, and complications of Caesarean section at the Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria.
 Materials and Methods: This research was carried out at the Department of Obstetrics and Gynaecology, Federal Medical Centre (FMC), Yenagoa, Bayelsa State, South-South, Nigeria between 1st January 2018 and 31st December 2020. It was a retrospective study.
 Data was retrieved from the labour ward records, delivery register, theatre records, and patients’ folders during the period under review, and entered into a pre-designed proforma.
 Data were analysed with IBM SPSS version 23.0. Results were presented in frequencies and percentages for categorical variables and mean and standard deviation for continuous variables.
 Results: About 959 women had Caesarean section (CS) out of 2,263 deliveries, giving a Caesarean section rate of 42.4%. The commonest indication for emergency Caesarean section was cephalopelvic disproportion (36.0%), while that for elective Caesarean section was repeat Caesarean section (19.6%).
 Conclusion: The Caesarean section rate in our Centre is extremely high, almost three times the acceptable upper limit set by the WHO. Encouraging vaginal birth after Caesarean section as a means to reduce this high rate is recommended as it was noted that previous Caesarean section was a leading indication for surgeries.

Values of Application of Three Delays Model to Maternal Mortality Scenarios at Sohag Univeristy Hospital Bidirectional Cohort Study

Background: Maternal mortality in Egypt is still relatively high so measuring maternal mortality and identifying its causes is essential and should be calculated regularly for the purpose of planning, monitoring and evaluation of provided maternal health care. Objective: Identifying the circumstances and causes of maternal mortality. Patient and method: Data were collected from records of patients who were presented to and delivered at Sohag University Hospital in the period between 2017 and 2019. Only cases of maternal mortality were included in this study. In our study we found 20 maternal deaths occurred at our hospital between 2017 and 2019. Results: In our study the most frequent one was the 1st delay that occurred in 10 women followed by 2nd delay in 4 women then combination of 1st and third in about 3 women and combination of 1st and 2nd in 2 cases and delay 2 in 1 case. Our study showed that the first cause of death was preeclampsia/eclampsia 55% followed by obstetric hemorrhage (placenta previa, postpartum hemorrhage, rupture uterus) 35%, caesarean section complications 5% and lastly medical condition associated with pregnancy 5%. Conclusions: This study showed that the first delay is the most important delay in Sohag, especially in rural areas, and the most important cause of death was preeclampsia and ignorance about its complications which was due to lack of antenatal care.

A Qualitative Inquiry to Explore Why Women with Previous Cesarean-Section Do Not Choose Vaginal Birth after Cesarean

Background Aim: Complications of cesarean-section are many times more than vaginal birth increase with repeat it, despite mothers don’t choose vaginal birth after CS. Aim: The aim of the present study is to explain why previous cesarean section mothers not to choose VBAC? Methods: A conventional content analysis performed by 25 participants from previous CS mothers (pregnant/non-pregnant) maternal health care providers through semi-structured individual interviews two focus group sessions in Om-Albanin hospital in Mashhad, Iran. The interviews lasted 30 - 90 minutes their content was recorded, transcribed analyzed using Graneheim & Lundman’s method (2004). Data validity was verified by Lincoln Guba criteria. Results: The main category of loneliness, weakness, in emerged from three subcategories: individual-social perspective, inefficient care psychological of childbirth. Sub-subcategories identified as: First sub-subcategory: opposite beliefs to non-supportive community non-supportive individual-social perspective. second includes: inadequate provision of optimal care , inadequate knowledge awareness , Weakness in decision self-efficacy and Weakness in effective counseling third includes: negative experiences of vaginal birth feeling of danger fear . Conclusion: The mothers are conflict in choosing VBAC in three aspects: social, care system individual dimensions. Comprehensive support including: cultural interventions for vaginal birth, planning a supportive special care system for previous CS mothers, increasing knowledge correcting beliefs will help them in decision self-efficacy. It is proposed planning of these strategies assess their effectiveness.

Vaginal Birth after Cesarean Section in Iran: A Narrative Review

Background & aim: birth after cesarean (VBAC) is a global solution to reduce the number and complications of repeat cesarean section (C-section); however, fear of consequences is an obstacle preventing its performance. Knowledge of research available in each country provides the support needed for making decisions regarding evidence-based actions for healthcare service providers in the country. This study aimed to review the studies performed to investigate VBAC in Iran. Methods: Search was carried out on Engliah and Persian databases including PubMed, Scopus, Google Scholar, Magiran, and SID. Retrieved articles up to October 2020 were included in the review and the search process was performed using the keywords of Vaginal birth after cesarean, Repeat C-section, Trial of labor after C-section, VBAC, and TOLAC. All related studies without time restriction were entered into the study, resulting in a total of 12 studies. Results: The success rate of VBAC varied from 27%-91.2% in different parts of Iran between 1981 and 2020. Moreover, maternal and neonatal adverse outcomes and cost and length of hospitalization were lower in the VBAC group. No related maternal death was reported in all reviewed studies. Conclusion: The findings of the present review indicated the lack of access to sufficient study resources on this field of research in Iran. Nevertheless, it is required to employ strategies as building an organizational culture, clinical contextualization at the level of healthcare services, and improving service environments, including VBAC supportive centers to promote this practice in the country.

Choriocarcinoma in Cesarean Scar Site: A Case Report

Background & aim: Cesarean scar pregnancy is an ectopic pregnancy implanted in the myometrium at the site of a previous cesarean section scar and is the rarest kind of ectopic pregnancy. The present study present a case of choriocarcinoma (CC) in the cesarean scar. The clinical course, findings, and treatment plan are discussed. Case report: A 41-years old multi-gravid woman with a history of one previous cesarean section and three subsequent abortions was admitted to the hospital. She suffered from an unknown abnormal vaginal bleeding for two months. Β-HCG titer was 1,000 IU/L and the report of sonography showed no gestational sac. Accordingly, the patient was diagnosed with ectopic pregnancy in the cesarean scar site and, therefore, weekly usage of methotrexate was prescribed for her. Since she did not respond to the treatment, she was referred to our department in the Faculty of Medicine. The evaluation showed mass invasion through the entire uterine wall. The uterus preservation was not possible, therefore, total hysterectomy was performed. The pathology report confirmed CC in the cesarean scar. Conclusion: Based on previous studies, as the number of cesarean sections increases, the possibility of complications rises, as well. Cesarean scars implantation of CC is one of the rare complications of caesarean section. The probability of a gestational trophoblastic disease should be considered in any woman during her pregnancy. Early detection and proper management of the complications can result in a decrease in morbidity and mortality.

Early maternal complications of cesarean section in two technique of Closure and non-closure of parietal peritoneum: a double blind randomized clinical trial

Introduction: Cesarean section is performed with two technique of closure or non-closure of the peritoneum, but there is disagreement about the advantages and disadvantages of these techniques. Accordingly, this study was performed with aim to compare the early maternal complications of cesarean section in two technique of closure or non-closure of the parietal peritoneum. Methods: This double-blind randomized clinical trial study was performed on 120 patients undergoing cesarean section at Hamadan Fatimah Hospital in 2019. Samples were randomly divided into two groups: closure of the peritoneum (n=60) and non-closure of the peritoneum (n=60). The maternal complications during and after surgery were recorded. Data were analyzed by SPSS software (version 21) and Chi-square, independent t-test and repeated measures. Results: The results showed that operative time and bleeding during surgery were significantly fewer in patients receiving non-closure technique (p 0.05). Conclusion: The complications such as bleeding during surgery, the duration of surgery, ileus after surgery, pain, and consumption of analgesic will occurs with less intensity in patients receiving non-closure technique than patients with closure technique; however, these two methods were not different in terms of surgical wound infection.

Common Complications of Cesarean Section During the Year 2017 in King Abdulaziz Medical City, Jeddah, Saudi Arabia.

Cesarean section (CS) is one of the most well-known major obstetrics surgeries and one of the oldest operations in the area of abdominal surgery. It is used for the purpose of delivering the newborn and the placenta through the abdominal wall incision (laparotomy) as well as Uterine incision (hysterotomy), followed by suture of the uterus and abdominal wall layers. Most common maternal complications internationally, according to literature were bleeding and wound infection. Most common fetal complications according to the literature were depressed Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score, low blood pH and ICU admissions. The aim of this study is to determine the most common CS complications among all the deliveries at King Abdulaziz Medical City (KAMC) in Jeddah in 2017 and to estimate maternal and fetal complication rates following CS. Comparing the rate of complication between residents and non-residents physicians performing a CS was tested as a secondary outcome. To the best of our knowledge, this is a novel research in this medical center at KAMC Jeddah that will aid in quality improvement in both clinical services and training activities of residents. The maternal and fetal complication rates were assessed in a cross-sectional chart review study. In order for this method to be achieved, a secondary data collection sheet was constructed to collect all eligible patient health records. This literature review was based on estimating the rate of CS complications for the mothers and their neonates that founded approximately 7% and 6%, respectively, where the procedure was either performed electively or emergently within the period of 1 January to 31 December 2017. Also, all patients with medical and surgical conditions were included while intrauterine fetal death was excluded. The most common maternal complications documented in our population were bleeding and wound extension, while the most common fetal complications were low APGAR score and NICU admissions. No statistical significance was found in either complications in terms of the correlation between demographical factors, maternal health conditions and gravida status. As for the secondary objective, the association between operator level of training and rate of complications revealed a higher percentage rate of maternal and fetal complications among consultants, which were 6.2% and 8.2%, respectively, mainly because the number and complexity of their cases in comparison to cases held by residents and others.

Cesarean section complications according to degree of emergency during labour

ObjectiveEvaluate the complications rate of cesarean section delivery based on degree of labour emergency. Study designMonocentric (Lille, France), retrospective study of all term, singleton, and cesarean deliveries during labour. Three groups were categorized based on the degree of emergency according to a color code: green (no time limit between surgical decision and birth), orange (birth within 30 min), and red (birth within 20 min). Scheduled cesareans were excluded. Complications were defined as minor/major and intra-/post-operative. ResultsA total of 881 patients were included. Among these, 303 (34.5 %) were in the green group, 353 (40.1 %) in the orange group, and 225 (25.4 %) in the red group. Major intra-operative complications, mainly postpartum hemorrhage, were more frequent in the red group compared with the green group (16.9 % vs. 9.9 %, p = 0.05; OR 1.9; 95 % CI [1.1–3.1]). Among the minor complications, there was no difference on moderate postpartum hemorrhage and four times uterine artery wounds in the red group (1.7 % vs. 7.1 %, respectively; p = 0.007; OR 4.6; 95 % CI [1.6–12.6]). The overall major post-operative complication rate, mainly infectious morbidity, was 6.1 % and this was more frequent in the red group compared with the green group (12.4 % vs. 1.7 %, respectively; p < 0.0001; OR 8.5; 95 % CI [3.2–22.3]). ConclusionPre- and post-operative complications of cesarean section delivery during labour (i.e., emergency cesarean) increase with the degree of labour emergency. It would be ideal to identify women in labour who are at increased risk of emergency cesarean earlier, so that the situation does not escalate to a red code cesarean.

Assessment of Mothers’ Knowledge toward Cesarean Section Complications at the Hospitals in Baghdad City Hospitals

Background: Cesarean section is one of the most frequently performed major abdominal surgeries andcarries the risk of infection, including local wounds, pelvic, respiratory tract, and urinary tract infections, aswell as lung emboli, venous thrombosis, and complications of anesthesia.Objective: The study aimed to assess mothers’ knowledge toward complications of cesarean section and tofind out the relationship between mothers’ knowledge and their demographic characteristics such as (age,level of education, and mulitiparacesarean section).Methodology: A descriptive (cross- section) study design was conducted on (100) mothers with cesareansection in the maternal ward. (The data were collected by the investigator, fill the questionnaire formatsby interview technique and fill it by the investigator). Questionnaire form was constructed for the purposeof the study. It consists of two parts which were dealing with the demographic characteristics of mothersand the mothers’ knowledge towards cesarean section complications. The data collection reliability ofthe questionnaire was determined through internal consistency. Content validity of the questionnaire wasdetermined through panel of experts. Data were analyzed through descriptive and statistical approach(frequency and percentage, and chi-square) by Socioeconomic Package for Social Science approach Version16.Results: The finding of the study demonstrated one result about the knowledge of mothers there was acceptedstatistical percentage between mothers’ knowledge and their demographic characteristics such as (age, levelof education, and multipara cesarean section).

Post-caesarean Niche (Isthmocele) in Uterine Scar: An Update.

Uterine niche is one of the emerging complications of caesarean section. With rising caesarean rates, the caesarean-related iatrogenic complications are also on the rise. These include placenta accreta, scar ectopic pregnancy and uterine niche which is a newer entity being described in the recent literature. Uterine niche, also described as uterine isthmocele, caesarean scar defect and diverticulum, is an iatrogenic defect in the myometrium at the site of previous caesarean scar due to defective tissue healing. Patients may have varied symptoms including abnormal uterine bleeding, post-menstrual spotting and infertility, though many women may be asymptomatic and diagnosed incidentally. Diagnosis is made radiologically by transvaginal sonography, saline instillation sonohysterography or magnetic resonance imaging. Occurrence of niche may be prevented by using correct surgical technique during caesarean. Patients may be managed medically; however, subfertility and persistent symptoms may require surgical correction either by hysteroscopic resection or transabdominal or transvaginal repair. This mini-review comprehensively covers the potential risk factors, clinical presentation, diagnosis and management of this increasingly encountered condition due to rising caesarean rates.

The changing perception and knowledge of obstetric fistula: a qualitative study.

To describe the knowledge and perceptions of obstetric fistula (OF) among affected and unaffected women. Twenty-five semi-structured interviews were conducted with women who had received OF repair. Three focus groups were conducted: one group of women with urinary incontinence but no OF, one group of women with OF, and one group of women without genitourinary complaints. Interviews and focus groups were conducted using the grounded theory approach. This study took place in two urban hospitals in Rwanda from April to November 2015. Transcripts were coded using MAXDA11 and analyzed using the axial technique and the constant comparative method. Nearly all participants correctly described OF and its symptoms, and 93% of interviewed women attributed OF to complications in vaginal delivery or cesarean section. Several participants described renouncing stigmatizing beliefs after learning about OF from the radio, health workers, or word of mouth. Still, it was found that women with OF were more knowledgeable about OF etiology than women without genitourinary conditions. Compared to prior studies, women's knowledge about OF appears to be more medically based, with media and health workers playing a role in reducing stigmatizing beliefs. These findings support continued investment in OF awareness campaigns, which seem to be increasing knowledge about OF and reducing stigma.

The incidence of postoperative nausea and vomiting after caesarean section in patients with hyperemesis gravidarum: a retrospective cohort study

BackgroundPostoperative nausea and vomiting is one of the most common anaesthetic complications of caesarean section. This study examined the association between hyperemesis gravidarum during pregnancy and nausea and vomiting after caesarean section. MethodsA single-centre, retrospective cohort study, using electronic databases of patients with and without hyperemesis gravidarum, undergoing caesarean section from 2015 to 2019. The incidence and severity of postoperative nausea and vomiting were established by a review of the documentation of administration of postoperative anti-emetics within the 24-h period after surgery, and examined using univariable, multivariable binary and ordered logistic regression models. ResultsData were compared for 76 patients with hyperemesis gravidarum and 315 patients without the condition. The incidence of postoperative nausea and vomiting in the hyperemesis group versus the non-hyperemesis group was 43.4% vs 29.6%, respectively. The odds of experiencing postoperative nausea and vomiting was 1.95 times higher in women with hyperemesis gravidarum than in those without (aOR 1.95, 95% CI 1.13 to 3.36, P=0.016). The odds of having more severe postoperative nausea and vomiting were greater in the hyperemesis gravidarum group (aOR 1.91, 95% CI 1.14 to 3.20, P=0.014). ConclusionPatients with hyperemesis gravidarum are more likely to develop nausea and vomiting after caesarean section, and this is likely to be of greater severity than in those without the condition. This finding should assist the effective provision of intra-operative and postoperative anti-emetics for patients with hyperemesis gravidarum undergoing caesarean section.

Comparing Early Postoperative Maternal Complications in Elective and Emergency Cesarean Sections

Background & aim: Scientifically, cesarean section (C-section) should be performed in case of emergency; however, the frequency of C-sections that are elective and without medical indication is high. This study aimed to compare the early postoperative maternal complications of elective and emergency C-sections. Methods: This descriptive study was carried out on a total of 120 patients undergoing elective and emergency C-sections at Fatemieh Hospital in Hamadan, Iran, between May to July 2019. The study participants were selected through convenient sampling from two groups of elective (N=60) and emergency C-sections (N=60). The data were collected using self-structured questionnaire on early maternal complications and were analyzed by SPSS software (version 23) using Chi-square and independent t-test. Results: A significant difference was observed between the two groups regarding the mean amount of intraoperative bleeding (P 0.05). Conclusion: The incidence rates of some maternal complications were relatively higher in the emergency C-section than those reported for elective C-section. Therefore, in order to prevent postoperative complications related to emergency C-section, gynecologists should be encouraged to decide timely for cesarean section if there is a particular indication. Also, it is required to provide considerable care to decrease the rate of maternal morbidity and mortality in these cases.

Intra-operative complications in repeat cesarean sections

Aims and Objectives: To study the intra-operative complications in repeat Cesarean sections. Methodology: This is a prospective observational study at Government Maternity Hospital, Tirupati randomly taking 200 women with repeat cesarean sections, excluding women with a history of other abdominal surgeries, intra operative complications were noted and the data is analysed using SPSS software. Results: Out of 200 cases 117 had one, 22 had two and 1case had three prior cesarean sections out of which 43% showed intra-operative complications, most common complications being adhesions (83.72%), thinned out lower uterine segment (37.2%), hemorrhage (10.9%), abnormal placentation (8.13%), extension of the uterine incision (6%), scar dehiscence (4.65%), bladder injury (1.2%). Conclusion: women undergoing repeat cesarean sections have a risk of increased morbidity due to increased intraoperative complications. To avoid this one should keep the cesarean section rate at reasonable limit with appropriate surgical techniques and to limit primary cesarean section rate.

Eremostachys laciniataas effective as rectal diclofenac suppository in cesarean section pain relief: A triple-blind controlled clinical trial

Background:Pain and distress are two common complications of cesarean section. Among complementary therapies, Eremostachys was introduced as a pain mitigator. This study aimed at investigating the effect of Eremostachys laciniata on cesarean section pain and distress.Materials and methods:This randomized clinical trial was conducted on 86 women who gave childbirth by cesarean section. The control group received 50 mg rectal diclofenac suppository every 8 h for 3 days, and the intervention group received 35 mg E. laciniata total extract suppository every 8 h up to three doses. Pain was measured with the Visual Analogue Scale at 8, 16, and 24 h after cesarean section. The Symptom Distress Scale was completed at 8 and 24 h after cesarean section. The Redness, Edema, Ecchymosis, Discharge, Approximation scale was completed 5 days after cesarean section.Findings:Pain score at 8, 16, and 24 h after surgery (15 min after intervention) was not significantly different between the intervention and control groups. The distress score 24 h after cesarean section showed a significant difference in favor of the control group according to Friedman’s test. There was a significant difference between the two groups in wound healing score, which indicated better efficacy of rectal diclofenac suppository than E. laciniata suppository. We assessed nausea, vomiting, headache, massive hemorrhage, and any type of anaphylactic reaction. No side events were observed in two groups.Conclusion:Rectal E. laciniata suppository could be introduced as a low-complication, appropriate, and effective medication in controlling pain and distress after cesarean section; more studies should be conducted on this matter.

Provider volume and maternal complications after Caesarean section: results from a population-based study

BackgroundA large literature search suggests a relationship between hospital/surgeon caseload volume and surgical complications. In this study, we describe associations between post-operative maternal complications following Caesarean section and provider caseload volume, provider years since graduation, and provider specialization, while adjusting for hospital volumes and patient characteristics.MethodsOur analysis is based on population-based discharge abstract data for the period of April 2004 to March 2014, linked to patient and physician universal coverage registry data. We consider all hospital admissions (N = 20,914) in New Brunswick, Canada, where a Caesarean Section surgery was recorded, as identified by a Canadian Classification of Health Intervention code of 5.MD.60.XX. We ran logistic regression models to identify the odds of occurrence of post-surgical complications during the hospital stay.ResultsRoughly 2.6% of admissions had at least one of the following groups of complications: disseminated intravascular coagulation, postpartum sepsis, postpartum hemorrhage, and postpartum infection. The likelihood of complication was negatively associated with provider volume and provider years of experience, and positively associated with having a specialization other than maternal-fetal medicine or obstetrics and gynecology.ConclusionsOur results suggest that measures of physician training and experience are associated with the likelihood of Caesarean Section complications. In the context of a rural province deciding on the number of rural hospitals to keep open, this suggests a trade off between the benefits of increased volume versus the increased travel time for patients.