Emergency Cesarean Section Group Research Articles

How does delivery method influence factors that contribute to women's childbirth experiences?

Backgroundwhether delivery method influences factors contributing to women's childbirth experience remains debated. Objectivewe compared subjective childbirth experience according to different delivery methods. Designthis study used a cross-sectional design. Settingthe setting comprised two university hospitals: one in Geneva, Switzerland and one in Clermont-Ferrand, France. Participantsa total of 291 primiparous women were recruited from July 2014 to January 2015 during their stay in the maternity wards. The mean age of the participants was 30.8 (SD=4.7) years, and most were Swiss or European (86%). Methodsthe ‘Questionnaire for Assessing Childbirth Experience’ was sent between four and six weeks after delivery. Clinimetric and psychometric approaches were used to assess childbirth experience according to delivery method. Measurements and findingsthe mean scores of the four questionnaire dimensions varied significantly by delivery method. ‘First moments with the newborn’ was more negatively experienced by women from the caesarean section group compared to those who delivered vaginally (p<0.001). Similar results regarding the dimension of ‘emotional status’ were also observed, as women who delivered by caesarean section felt more worried, less secure, and less confident (p=0.001). ‘Relationship with staff’ significantly differed between groups (p=0.047) as more negative results were shown in the ‘unexpected medical intervention groups’ (i.e. emergency caesarean section and instrumental delivered vaginally). Women's ‘feelings at one-month post partum’ in the emergency caesarean section group were less satisfactory than the other groups. Delivery method and other obstetric variables explained only a low proportion of the total variance in the global scores (R2adjusted=0.18), which emphasized the importance of subjective factors in women's childbirth experience. Key conclusionsa comparison of best expected positive responses to each item (clinimetric approach) showed useful results for clinicians. This research indicated that delivery method influenced key factors (psychometric approach) of the childbirth experience. Implications for practicedelivery method should not be considered alone and health professionals should focus on what is important for women to foster a more positive experience. In addition, women who have had an emergency caesarean section require special attention during post partum.

Serial Change in Cervical Length for the Prediction of Emergency Cesarean Section in Placenta Previa.

PurposeTo evaluate whether serial change in cervical length (CL) over time can be a predictor for emergency cesarean section (CS) in patients with placenta previa.MethodsThis was a retrospective cohort study of patients with placenta previa between January 2010 and November 2014. All women were offered serial measurement of CL by transvaginal ultrasound at 19 to 23 weeks (CL1), 24 to 28 weeks (CL2), 29 to 31 weeks (CL3), and 32 to 34 weeks (CL4). We compared clinical characteristics, serial change in CL, and outcomes between the emergency CS group (case group) and elective CS group (control group). The predictive value of change in CL for emergency CS was evaluated.ResultsA total of 93 women were evaluated; 31 had emergency CS due to massive vaginal bleeding. CL tended to decrease with advancing gestational age in each group. Until 29–31 weeks, CL showed no significant differences between the two groups, but after that, CL in the emergency CS group decreased abruptly, even though CL in the elective CS group continued to gradually decrease. On multivariate analysis to determine risk factors, only admissions for bleeding (odds ratio, 34.710; 95% CI, 5.239–229.973) and change in CL (odds ratio, 3.522; 95% CI, 1.210–10.253) were significantly associated with emergency CS. Analysis of the receiver operating characteristic curve showed that change in CL could be the predictor of emergency CS (area under the curve 0.734, p < 0.001), with optimal cutoff for predicting emergency cesarean delivery of 6.0 mm.ConclusionsPrevious admission for vaginal bleeding and change in CL are independent predictors of emergency CS in placenta previa. Women with change in CL more than 6 mm between the second and third trimester are at high risk of emergency CS in placenta previa. Single measurements of short CL at the second or third trimester do not seem to predict emergency CS.

New evaluation of fetal oxidative stress: measurement of the umbilical cord blood dimethyl sulfate-induced ascorbyl-free radical by an electron spin resonance method

Objective: The aim is to evaluate intrapartum fetal oxidative stress in real-time by umbilical cord blood dimethyl sulfate (DMSO)-induced ascorbyl-free radical (AFR) measured by an electron spin resonance (ESR) method.Methods: Seventy-five mothers delivering at gestational age after 37 weeks were recruited. They were divided into three groups: spontaneous vaginal birth (n = 27), elective cesarean section (CS) (n = 34), and emergency CS due to non-reassuring fetal status (n = 14). Umbilical artery (UA) and venous (UV) cord blood gas analysis was performed. Serum levels of DMSO-induced AFR (AFR/DMSO) that reflect vitamin C concentrations were measured by ESR spectroscopy.Results: Blood gas analysis showed no significant differences among the groups. UA-AFR/DMSO level of elective CS group was significantly lower compared with spontaneous delivery group (0.32 ± 0.12 versus 0.46 ± 0.14, p < 0.005). Emergency CS group showed significantly lower levels of UA-AFR/DMSO compared with elective CS group (0.25 ± 0.11 versus 0.32 ± 0.12, p < 0.005). UV-AFR/DMSO levels had no significant difference among the groups.Conclusions: It is suggested that fetal cord blood AFR/DMSO is a sensitive marker to assess fetal oxidative stress during delivery.

ACTH and cortisol cord plasma concentrations in preterm and term infants

To measure the adrenocorticotropic hormone (ACTH) and cortisol (F) cord plasma levels in preterm and term infants in relation to their mode of delivery. We studied 180 newborns appropriate for gestational age (GA) with birth weights between 365 and 4380 g and GAs between 21 and 41 weeks divided into three groups: born by vaginal delivery (VD), elective cesarean section (ECS) and emergency cesarean section (EMCS). ACTH and F levels were valued with enzyme-linked immunosorbent assay testing. Median concentrations were compared between groups by Student's T-test for independent and paired data. Multiple regression analysis was used to investigate the effect of GA on F and ACTH concentrations. A significant positive correlation between GA and plasma concentrations of ACTH (P<0.05) was found in the whole population, but not between GA and F (P=NS). A significant positive correlation was found between GA and plasma concentrations of both ACTH (P=0.01) and F (P=0.03) in VD. In those born by ECS, we demonstrated a positive correlation not only between plasma concentrations of ACTH (P=0.0000) and F (P=0.00002), respectively, with GA, but also a correlation between ACTH and F (P=0.0004). No significant correlations were found in the EMCS group (P=NS). Our results suggest simultaneous pituitary-adrenal maturation, which is complete only at term. The responsiveness of preterm babies to different stressful stimulations is similar to the terms' but quantitatively lower, and the secretion of ACTH and F may not suffice in severe pathological circumstances.

746: Does the neonatal impact of chorioamnionitis in the setting of PPROM vary depending on degree of prematurity?

setting of PPROM vary depending on degree of prematurity? Shireen de Sam Lazaro, Yvonne Cheng, Jonathan Snowden, Leonardo Pereira, Natali Aziz, Aaron Caughey Oregon Health and Science University, Obstetrics and Gynecology, Portland, OR, University of California-San Francisco, Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA, Stanford, Obstetrics and Gynecology, Palo Alto, CA OBJECTIVE: To examine if neonatal outcomes vary based on the diagnosis of chorioamnionitis in the setting of pregnancies complicated by preterm premature rupture of membranes, (PPROM) and whether this difference varies by gestational age. STUDY DESIGN: A retrospective cohort study was conducted of all pregnancies complicated by PPROM who delivered between 24 to 36 weeks and 6 days gestation in 2006 in California (n 5229). Pregnancies were grouped by gestational age, and patients who delivered with a diagnosis of chorioamnionitis were compared to patients without this diagnosis. Neonatal outcomes were assessed including necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), and sepsis. Dichotomous outcomes were compared using Fisher’s exact test, with P 0.05 indicating statistical significance. RESULTS: 5,229 women were diagnosed with PPROM between 24 weeks to 36 weeks 6 days, and 306 (5.9 %) women were diagnosed with chorioamnionitis prior to delivery during the study period. Neonates born to mothers diagnosed with chorioamnionitis were noted to have significantly higher rates of sepsis across each gestational age (Table). Additionally, amongst the most premature infants, an association between chorioamnionitis and IVH was noted, though this did not reach statistical significance. Chorioamnionitis was not noted to affect the rate of necrotizing enterocolitis across the gestational ages. CONCLUSION: Patients who develop chorioamnionitis in the setting of PPROM are at an increased risk of neonatal sepsis. Additionally, the most premature infants delivered in the setting of chorioamnionitis may be an increased risk of intraventricular hemorrhage. No increased risk for necrotizing enterocolitis was noted amongst neonates delivered with chorioamnionitis compared to those without that diagnosis across all gestational ages. 747 Clinical significance of elevated high-sensitivity C-reactive protein in amniotic fluid obtained at emergency caesarean section Zbigniew Marchocki, Maurice O’Donoghue, Kevin Collins, Keelin O’Donoghue Cork University Maternity Hospital, University College Cork, Obstetrics & Gynaecology, Cork, Ireland, Cork University Maternity Hospital, University College Cork, Microbiology, Cork, Ireland OBJECTIVE: Delivery by caesarean section (CS) is the single most important factor associated with post-partum infection. Risk factors include obesity, prolonged operating time, poor surgical technique and emergency delivery. While the majority of infections are not life threatening they have implications on length of hospital stay, costs and re-admission rates. We examined high-sensitivity C-reactive protein (HS-CRP) levels in amniotic fluid (AF) and maternal serum at the time of CS and correlated results with risk factors for infection and postpartum infectious complications. STUDY DESIGN: This was a prospective observational study of women undergoing elective and emergency CS. AF for HS-CRP analysis was obtained at CS by direct needle aspiration from the intact amnion. Maternal serum HS-CRP was measured before and 3 days after CS. Results were correlated with maternal and neonatal outcomes. RESULTS: Seventy-four women had AF samples collected at CS; of these 53% (39/74) underwent emergency CS. There was a significant difference in HS-CRP in AF at emergency CS, with levels on average 10 fold higher (p 0.009). No difference in AF HS-CRP levels was noted in women with BMI 25 or between smokers. In the emergency CS group, AF HS-CRP levels were not affected by length of labour, fetal blood sampling or pyrexia in labour. However there was a significant difference in AF HS-CRP levels in women who had multiple ( 7) vaginal examinations in labour (p 0.003). Overall, 11% of women developed post-partum infectious complications, but there was no difference in AF HS-CRP levels. Six neonates were admitted to NICU with suspected infection; AF or serum HS-CRP levels were not significantly different. CONCLUSION: AF HS-CRP levels were significantly higher after emergency CS. Changes in AF HS-CRP levels were not associated with early post-partum infectious morbidity among mothers and babies, but our findings are limited by small sample size and further study may determine clinical significance.

New evaluation of fetal oxidative stress: measurement of the umbilical cord blood dimethyl sulfate-induced ascorbyl free radical by an electron spin resonance method

Objective: The aim is to evaluate intrapartum fetal oxidative stress in real-time by umbilical cord blood dimethyl sulfate (DMSO)-induced ascorbyl free radical (AFR) measured by an electron spin resonance (ESR) method. Methods: 75 mothers delivering at gestational age after 37 weeks were recruited. They were divided into three groups: spontaneous vaginal birth (n = 27), elective cesarean section (CS) (n = 34), and emergency CS due to non-reassuring fetal status (n = 14). Umbilical artery (UA) and venous (UV) cord blood gas analysis was performed. Serum levels of DMSO-induced AFR (AFR/DMSO) that reflect vitamin C concentrations, was measured by ESR spectroscopy. Results: Blood gas analysis showed no significant differences among the groups. UA-AFR/DMSO level of elective CS group was significantly lower compared with spontaneous delivery group (0.32 ± 0.12 vs. 0.46 ± 0.14, p < 0.005). Emergency CS group showed significantly lower levels of UA-AFR/DMSO compared with elective CS group (0.25 ± 0.11 vs. 0.32 ± 0.12, p < 0.005). UV-AFR/DMSO levels had no significant difference among the groups. Conclusions: It is suggested that fetal cord blood AFR/DMSO is a sensitive marker to assess fetal oxidative stress during delivery.

Breech presentation at a district level hospital in South Africa

SA Fam Pract 2010;52(1):64-68 Introduction: The Term Breech Trial has led to obstetricians opting for Caesarean section as the mode of delivery for this presentation, even in poor countries. Concerns related to this approach are the resultant increase in Caesarean section rates and their associated complications, particularly in under-resourced countries, which are faced with financial and human-resource expertise constraints. Method: This was a retrospective chart review of women who presented at term with a singleton breech presentation at the antenatal clinic and in labour, from January 2005 to December 2007, at a district level hospital in South Africa. Results: There was a total of 19 197 deliveries, of which 466 were singleton term breech deliveries, giving a rate of 2.4%. Of the 297 women who had antenatal care and had been allocated to planned Caesarean section, 271 had the planned operation. There were no neonatal deaths in the planned Caesarean section group. The emergency Caesarean section group and the group in which no decision was made on the mode of delivery were associated with higher maternal complication rates than in the group that had planned Caesarean sections. The highest neonatal complication rate was in the group that had unplanned vaginal deliveries. Conclusion: In a district hospital in South Africa, the mode of delivery for breech presentations is usually a planned Caesarean section. Unplanned vaginal deliveries are associated with significant perinatal mortality. Peer reviewed. (Submitted: 2009-03-05, Accepted: 2009-08-10). © SAAFP

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Very-low-birth-weight infants (VLBWI) are frequently delivered by cesarean section (CS). However, it is unclear at what gestational age the benefits of spontaneous delivery outweigh the perinatal risks, i.e. intraventricular hemorrhage (IVH) or death.To assess the short-term outcome of VLBWI on IVH according to mode of delivery in a population-based cohort of the German Neonatal Network (GNN).A total cohort of 2203 singleton VLBWI with a birth weight <1500 g and gestational age between 22 0/7 and 36 6/7 weeks born and discharged between 1st of January 2009 and 31st of December 2015 was available for analysis. VLBWI were stratified into three categories according to mode of delivery: (1) planned cesarean section (n = 1381), (2) vaginal delivery (n = 632) and (3) emergency cesarean section (n = 190). Outcome was assessed in univariate and logistic regression analyses.Prevalence of IVH was significantly higher in the vaginal delivery (VD) (26.6%) and emergency CS group (31.1%) as compared to planned CS (17.2%), respectively. In a logistic regression analysis including known risk factors for IVH, vaginal delivery (OR 1.725 [1.325–2.202], p ≤ 0.001) and emergency cesarean section (OR 1.916 [1.338–2.746], p ≤ 0.001) were independently associated with IVH risk. In the subgroup of infants >30 weeks of gestation prevalence for IVH was not significantly different in VD and planned CS (5.3% vs. 4.4%).Our observational data demonstrate that elective cesarean section is associated with a reduced risk of IVH in preterm infants <30 weeks gestational age when presenting with preterm labor.

Psychological impact of emergency Cesarean section in comparison with elective Cesarean section, instrumental and normal vaginal delivery

The purpose of the study was to compare the psychological reactions of women after emergency Cesarean section (EmCS), elective Cesarean section (ElCS), instrumental vaginal delivery (ND) and normal vaginal delivery (NVD). The participants (EmCS n = 71, ElCS, n = 70, IVD, n = 89, and NVD, n = 96) answered questionnaires a few days postpartum and 1 month postpartum. The EmCS group reported the most negative delivery experience at both times, followed by the IVD group. At a few days postpartum the EmCS group experienced more general mental distress than the NVD group, but not when compared with the ElCS or the IVD groups. At 1 month postpartum the EmCS group showed more symptoms of post-traumatic stress than the ElCS and NVD groups, but not when compared to the IVD group. An unplanned instrumental delivery (EmCS or IVD) should be regarded as a pointer with respect to possible post-traumatic stress.

Umbilical cord blood erythroblast count as an index of intrauterine hypoxia.

The relation of umbilical cord blood arterial pH, Apgar score, leucocyte count, and erythroblast count at delivery with the diagnosis of fetal distress in labour was studied prospectively in three groups of singleton pregnancies delivering at term vaginally (55 infants), by elective caesarean section (39 infants), or by emergency caesarean section for abnormal intrapartum fetal heart rate patterns (55 infants). In the emergency caesarean section group the umbilical cord blood arterial pH was significantly lower and the leucocyte and erythroblast counts were higher than in the elective caesarean section group. Comparison of the emergency caesarean section and spontaneous vaginal delivery groups showed significant differences for pH and erythroblast count, but not for leucocyte count. In the spontaneous vaginal delivery group erythroblastosis was associated with umbilical cord blood pH, whereas leucocytosis was associated with the length of labour. The five minute Apgar score was > or = 7 in all infants. This study suggests that leucocytosis is a non-specific response of the fetus to labour, whereas erythroblastosis reflects fetal tissue hypoxia.

Prévention de la pneumopathie d'inhalation en anesthésie obstétricale par l'association effervescente cimétidine-citrate de sodium

The effect of an oral effervescent formulation combining 200 mg cimetidine and 1.8 g sodium citrate on gastric pH and volume were studied in patients undergoing caesarean section. Seventy-four patients undergoing elective (group 1) or emergency caesarean section (group 2) were included. Before entering the operating theater (5 to 60 min before intubation), they were given the tablet dissolved in 15 ml of water. Induction and maintenance of anaesthesia were carried out with conventional techniques. The patient's gastric content was aspirated just after endotracheal intubation, and before extubation. Its pH and volume were measured at both times. Mean pH was similar in the two groups after intubation (6.07 ± 1.13 in group 1 ; 5.52 ± 1.14 in group 2) and before extubation (6.32 ± 1.08 vs. 5.85 ± 1.02 respectively). Gastric pH was therefore > 2.5 in all 74 patients at both times. Mean volumes of gastric content after intubation were greater in group 2 (32.7 ± 23.9 ml vs. 21.6 ± 15.8 ml; p < 0.02). However, just before extubation, these were similar (15.0 ± 15.4 ml in group 1, 20.1 ± 14.9 ml in group 2). The percentage of patients in the 2 groups with gastric volumes > 25 ml at the time of intubation were not significantly different (29.7 % vs. 45.9 % respectively). No patient was at risk of developing pneumonitis in case of aspiration (gastric content pH < 2.5 and volume > 25 ml), either during endotracheal intubation or extubation. Effervescent cimetidine with sodium citrate therefore might be very efficient in preventing aspiration pneumonitis in obstetrical anaesthesia; this was especially so in emergency surgery, where the increase in gastric pH lasted until extubation. Moreover, gastric content volumes compared favourably with those found in studies where 30 ml of 0.3 M sodium citrate had been used.

Acid aspiration prophylaxis in Australian obstetric hospitals--a survey.

During 1987 a confidential survey of all hospitals in Australia providing obstetric services was undertaken to determine the antacid medications used routinely as prophylaxis against acid aspiration pneumonitis. Of the 567 hospitals surveyed, 379 (67%) responded. Of these, 243 hospitals provide an obstetric service which includes caesarean section, and 67% of these perform less than 500 deliveries per annum. Aspiration prophylaxis during labour was used in 22.4% of responding hospitals. Prior to elective caesarean section, 11.5% used no prophylaxis, and 39.4% used particulate antacids such as magnesium trisilicate mixture (33.3%) or Mylanta (6.1%). Sodium citrate mixture was the most popular therapy (37%). Results were similar in the emergency caesarean section group. The use of cimetidine or ranitidine was uncommon in all groups. Results of this survey suggest marked differences in attitudes towards acid aspiration prophylaxis between Australian and British obstetric anaesthetic practices.

Fetal plasma steroids in relation to parturition. II. The effect of gestational age upon umbilical plasma corticosteroids following hysterotomy and Caesarean section.

SummaryTotal plasma corticosteroid levels were measured by competitive protein binding assay in matched umbilical arterial and venous samples obtained immediately following delivery of 78 infants by Caesarean section. At 38 to 40 weeks gestation, the mean umbilical arterial levels (±S.E.) were 94.9 ± 10.0 ng./ml. following elective Caesarean section and 142.2 ± 23.7 ng./ml. following emergency Caesarean section in labour. The corresponding mean venous levels were 132.3 ± 10.0 ng./ml. and 172.9± 19.1 ng./ml. Within the emergency Caesarean section group, corticosteroid levels were related to the stage of labour. In fetuses obtained by hysterotomy, the mean heart blood level of plasma corticosteroids was 16.3±3.6 ng./ml. at 12 to 16 weeks gestational age. Within the elective Caesarean group, corticosteroid levels increased with gestational age, reaching a peak at 35 to 37 weeks gestation.