Indication For Abdominal Delivery Research Articles

CESAREAN SECTION IN CASES OF STRESS-COMPROMISED PREGNANCY IN WOMEN WITH UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA.

The aim: Assessment of abdominal delivery by cesarean section in preterm pregnancies in women with undifferentiated connective tissue dysplasia. Materials and methods: Analyzed were 3,371 cases of cesarean section deliveries in preterm pregnancies complicated by undifferentiated connective tissue dysplasia (UCTD). Based on a scoring assessment of external and visceral UCTD markers, three groups were identified: Group 1 included 466 patients with no signs of UCTD, Group 2 consisted of 798 patients with mild UCTD, and Group 3 comprised 2,107 patients with moderate to severe UCTD. The severity of connective tissue dysplasia manifestations was assessed based on external and internal signs of connective tissue dysplasia, as well as gynecological and obstetric history, indications for abdominal delivery in preterm pregnancies, and maternal and perinatal outcomes of the deliveries. Results: It has been established that in 71.4% of patients with stress-compromised pregnancies resulting in preterm birth and delivered by cesarean section, the most common indications were: inability of the uterine scar in 23.8%, breech presentation of the fetus in 19.1%, and detachment of the normally placed placenta in 4.9%. An unfavorable factor was moderate to severe connective tissue dysplasia, which led to a 5-fold increase in the likelihood of requiring a cesarean section. In addition, severe hypoxia in newborns was significantly more frequently observed in the first minutes of life in cases of moderate and severe UCTD. Conclusions: The conducted studies have shown that cesarean sections in cases of stress-compromised pregnancies resulting in preterm birth are performed significantly more often in cases of moderate to severe undifferentiated connective tissue dysplasia (UCTD). Moderate and severe UCTD have a substantial impact on obstetric and perinatal outcomes of deliveries, both at present and in the future.

Pregnant Women Aspects Regarding Childbirth Preferences at Univiversity Hospital

Introduction: Pregnancy is a unique experience in a women's life, fulfilled with expectations, surrounded by uncertainties and cultural resistances. The present study describes pregnant women their major concerns regarding childbirth preferences. Methods: Descriptive study of serial samples acquired from May 1st of 2010 until June 30th of 2010. A questionnaire was applied to 400 pregnant women in ULBRA University Hospital rooming-in care facility, regarding variables concerning preferences on childbirth delivery. Results: Gravida's preference of vaginal delivery was observed at 72.8% of the time. Their main arguments for such preference were: faster recovery, lesser pain and suffering, faster method of delivery and decreased risk of mother's death. Variables concerning their choice of way of delivery were: presence of a partner, educational level, home income, and time rupture of membranes. Main medical indication for cesarean-section was cephalopelvic disproportion (22.6%), and 35% of the women believed that it was failure of labor induction, their indication for abdominal delivery. Conclusion: Vaginal delivery found to be their preferable way of delivery (n=291). Group who preferred vaginal delivery profile: younger age, highest level of education, higher income, having a fixed partner, and shorter time of membrane rupture. Discordance among gravida's alleged causes and medical indication for cesarean section was observed.

Complications associated with macrosomic fetus in Calabar South Eastern Nigeria

A retrospective study to determine adverse perinatal outcome associated with macrosomic births was carried out at the University of Calabar Teaching Hospital, Calabar (1994-2000). The incidence of macrosomic births was 1 in 25 deliveries. Perinatal mortality rate (PNMR) was 83 per 1000 births was highest in the birth weight range of 4.0 – 4.4kg (P = 0.004) and in macrosomic babies born by caesarean section (P=0.0019). The commonest indication for abdominal delivery was obstructed labour (14.4%) with an associated PNMR of 21.8 per 1000 births. Perinatal morbidity and mortality were seen in 25.3% of cases. Perinatal mortality is significantly high in the birth weight range of 4.0-4.4kg and in babies born abdonminally, mainly because of obstructed labour and ruptured uterus. Intervention before these complications occur may significantly reduce the adverse pregnancy outcome associated with macrosomic births. Keywords : fetal complications, macrosomia Mary Slessor Journal of Medicine Vol. 5(2) 2005: 5-7

Caesarean section for the second twin after vaginal delivery of first

Although caesarean section of a second twin after vaginal birth of the first twin is rare, it nevertheless has clinical importance as an acute emergency situation with high perinatal morbidity and mortality. We therefore found it appropriate to describe the obstetric management of such cases, including an overview of the literature and our own data. According to reports in the literature, 113 deliveries of second twins (3.4%) were carried out by section in 3342 twin births. At our department in Tubingen there were 497 twin births (1.9%) in 26 095 births. Of these the second twin was delivered by section in 11 cases (2.2%). This represents a statistical frequency of 0.04% of all births. As shown by case histories and our own study, the indications for abdominal delivery of the second twin were predominantly the prolapse of the umbilical cord or of small parts due to transverse or breech presentation, with simultaneous retraction of the cervix. Of our 11 births with emergency section, one child died postpartum. Because of above-mentioned risks the twin delivery must always be performed in a fully equipped facility, including facilities for intensive neonatal care.

Investigation of institutional differences in primary cesarean birth rates

Differences in primary cesarean birth rates between a maternity center staffed by certified nurse-midwives (CNM) with physician backup on the premises and a university teaching hospital staffed by resident and attending physicians were studied. The study sample included 796 and 804 women, similar in demographics, who received their prenatal and intrapartum care in the respective sites in 1977 and 1978. Study results indicate a significantly lower rate of primary cesarean birth at the maternity center than at the university hospital that was independent of institutional differences in the indications for abdominal delivery. Although cesarean birth was related to contracted pelvis (at labor), fetal representation, and placental bleeding at both institutions, it was significantly associated with preeclampsia, primiparity, fetal distress, and maternal age only at the university hospital. There were no noteworthy differences in pregnancy outcomes for women delivered vaginally or by cesarean, except for more newborns with low Apgar scores among primary cesarean births at the university hospital. A likely explanation for these findings is differing labor and delivery management styles between the providers of care at the two institutions.

Radiologic evidence of a nuchal arm in the breech-presenting fetus at the onset of labor: an indication for abdominal delivery.

The occurrence of a nuchal arm during vaginal breech delivery is a potentially traumatic event associated with high perinatal morbidity and mortality. This problem usually cannot be anticipated and must be overcome immediately on diagnosis during the second stage of labor. The results of a retrospective analysis of radiologic studies of 115 cases of term singleton breech deliveries are presented here. A nuchal arm in the first stage of labor was diagnosed in five cases, an incidence of 4.35%. Of four vaginal breech deliveries, one case resulted in severe handicapping neonatal trauma. We suggest that radiologic diagnosis of a nuchal arm in the first stage of labor should indicate abdominal delivery.

Development of babies delivered by cesarean section

In order to prevent maternal and perinatal mortality, there has been a clear trend in the last decade to expand the indications for abdominal delivery. The frequency of cesarean section, according to different authors, ranges from 3-6.5 to 21.6%. At the same time, the immediate, short-term, and long-term results of cesarean section for a baby are insufficiently covered in the literature, and methodological approaches to nursing this group of children are not developed accordingly. Doctors often do not distinguish between abdominally and naturally delivered babies, and in some cases they consider cesarean section to be the optimal method of delivery for the fetus and the newborn. The first results of physiological studies of children born by cesarean section indicate that this operation is not indifferent to the newborn.

Prophylactic antibiotics for cesarean delivery: A simple cost-effective strategy for prevention of postoperative morbidity

Postoperative endomyometritis is the most common complication associated with cesarean delivery. The frequency of endomyometritis varies from 5% to 85% (mean 35% to 40%), depending on the socioeconomic characteristics of the patient population and the indication for abdominal delivery. In women undergoing cesarean section after extended duration of labor and ruptured membranes, the use of prophylactic antibiotics has been consistently effective in decreasing the frequency of endomyometritis. A single dose of antibiotic administered after the umbilical cord is clamped provides a degree of prophylaxis comparable to that achieved with two- and three-dose regimens. There is no evidence that the newer extended-spectrum cephalosporins or penicillins are better for prophylaxis than ampicillin or a first-generation cephalosporin. Administration of antibiotics by intraoperative irrigation is an acceptable, but not superior, alternative to systemic antibiotic administration. Prophylactic antibiotics alter the vaginal flora after operation, but to date harmful clinical effects have not occurred as a result of such alteration.

ROBOTS '86 in Chicago, April 21–24, 1986 to Stress Integrated Manufacturing

ROBOTS '86 in Chicago, April 21–24, 1986 to Stress Integrated Manufacturing

Sterilization at the time of cesarean section: Tubal ligation or hysterectomy?

The operative, postoperative and subsequent course of 86 patients who underwent cesarean hysterectomy (C.H.) during the years 1970–1979 are compared to an equal number of cesarcan sections with tubal ligation (C.S.L.). Both groups are similar reqarding age, gravidity, parity, number of living children and indications for abdominal delivery. Operative and postpartum complications of both groups were all minor, although significantly (p < 0.05) more frequent in the C.S.L. group. More patients of the C.H. group required blood transfusions than the C.S.L. group (p < 0.01). The mean period of hospitalization was similar in both groups. Two pregnancies occurred after tubal sterilization, a failure rate of 1:43. During the follow-up period, 49 surgical gynecological procedures were performed in the C.S.L. group compared to 1 in the C.H. group. Ten patients of the C.S.L. group subsequently underwent abdominal hysterectomy. Hysterectomy is the procedure of choice for permanent sterilization and prevention of many subsequent gynecological problems. Consideration must be given to coexisting gynecological conditions while considering sterilization at elective C.S. and C.M. should be offered to those patients.

PRIMARY CESAREAN SECTION IN THE MULTIPARA

Abstract 1. Primary cesarean section performed in a municipal and in a voluntary hospital on 186 multiparous mothers with a pregnancy of 28 weeks or over were reviewed for the 10 year period between 1950 and 1960. 2. During this study period, 36,277 women were delivered. The cesarean section incidence was 3.3 per cent. The incidence among ward patients was 2.3 per cent, while that of the private patients was 4.4 per cent. The incidence of primary cesarean section in the multipara was 0.51 per cent or one in every 195 deliveries. 3. Hemorrhage stands out as the most frequent indication for primary cesarean section in the multigravida. 4. Fetopelvic disproportion was the second leading cause for abdominal delivery. The concept that multiparous patients rarely have fetopelvic disproportion has resulted in undue delay in performing cesarean section. A multigravida in labor, with an unengaged presenting part, should receive the same careful investigation as the primigravida. 5. The validity of our indications for primary cesarean section were critically reviewed. In 86.5 per cent of the patients, the operations were considered valid, 2.2 per cent were doubtful, and 11.3 per cent were not justified. Hemorrhage was responsible for 62 per cent of the nonvalid sections while fetal distress contributed 28.5 per cent. 6. A more conservative approach to antepartum bleeding in certain multiparous patients and the avoidance of oxytocin-induced fetal distress in others, should lower the incidence of cesarean sections in the multigravida. 7. The maternal mortality incidence was 0.53 per cent. 8. The gross perinatal mortality was 11.6 per cent. The causes of fetal deaths and the risks inherent in the indications for abdominal delivery are discussed.

Primary cesarean section in the multipara

1. Primary cesarean section performed in a municipal and in a voluntary hospital on 186 multiparous mothers with a pregnancy of 28 weeks or over were reviewed for the 10 year period between 1950 and 1960.2. During this study period, 36,277 women were delivered. The cesarean section incidence was 3.3 per cent. The incidence among ward patients was 2.3 per cent, while that of the private patients was 4.4 per cent. The incidence of primary cesarean section in the multipara was 0.51 per cent or one in every 195 deliveries.3. Hemorrhage stands out as the most frequent indication for primary cesarean section in the multigravida.4. Fetopelvic disproportion was the second leading cause for abdominal delivery. The concept that multiparous patients rarely have fetopelvic disproportion has resulted in undue delay in performing cesarean section. A multigravida in labor, with an unengaged presenting part, should receive the same careful investigation as the primigravida.5. The validity of our indications for primary cesarean section were critically reviewed. In 86.5 per cent of the patients, the operations were considered valid, 2.2 per cent were doubtful, and 11.3 per cent were not justified. Hemorrhage was responsible for 62 per cent of the nonvalid sections while fetal distress contributed 28.5 per cent.6. A more conservative approach to antepartum bleeding in certain multiparous patients and the avoidance of oxytocin-induced fetal distress in others, should lower the incidence of cesarean sections in the multigravida.7. The maternal mortality incidence was 0.53 per cent.8. The gross perinatal mortality was 11.6 per cent. The causes of fetal deaths and the risks inherent in the indications for abdominal delivery are discussed.

Cesarean section in detroit during 1945—A comparison with 1925 and 1930

Cesarean section in detroit during 1945—A comparison with 1925 and 1930