Indication For Caesarean Section Research Articles

Comparison between extraperitoneal and transperitoneal cesarean section: Retrospective case-control study.

The main advantage of extraperitoneal cesarean section (EXPCS) is not only less pain, faster recovery, and less potential for infection but also a possible lack of intraperitoneal adhesions. In a 3-year period from 2019 to 2022, 88 EXPCSs were performed. A comparison was made with 90 patients who underwent a standard transperitoneal cesarean section (TPCS). For both groups, the inclusion criterion was uterine inertia and prolonged labor as an indication for cesarean section. Only pregnant women from 37 to 42 weeks were included. After this, 51 patients remained in the EXPCS arm, and 49 remained in the TPCS arm. No statistical difference was found in gestational weeks, newborn weight, Apgar score, erythrocyte (Er), hemoglobin (Hgb), and hematocrit (Htc) values and duration of operative time between the EXPCS and TPCS groups. Leukocytes, C-reactive protein (CRP) with fever higher than >38°C on the third postoperative day were found statistically significantly (p=0.005) higher in the TPCS group. The usage of tramadol + metamizole at 3, 6, and 9 hours after delivery and diclofenac at 6, 12, and 18 hours after surgery was statistically significantly (p<0.05) higher in the TPCS group. On the visual analog scale (VAS) 24 hours after surgery, a statistically significant difference was found (p = 0.001) between the two groups. In the small group of patients who underwent a TPCS section after an EXPCS, intraperitoneal adhesions were not found; in another group of patients who underwent a TPCS twice, adhesions were found in 12 patients; Fisher's exact test (p=0.04). The protective effect of EXPCS for infection could be proven in prolonged delivery. EXPCS could be a good solution in the fight against adhesions and infection in women who undergo second, third, or even fourth cesarean sections.

Comparison of the rate and indications of caesarean section in primigravida and multigravida in a maternity hospital of Pakistan.q

Objective: To compare the causes and rate of caesarean section in primigravida and multigravida. Study Design: Cross-sectional study. Setting: Government Maternity Hospital, Peshawar. Period: January 2021 to January 2022. Methods: The study included all primigravida with 37-42 weeks period of gestation, and multigravida (gravida 2-12) with the same gestational period. Similarly, all the multigravida who delivered previously by C-section or had normal vaginal delivery with the viable fetus and currently delivered by C-section, were also included. Cases having history of ruptured uterus, nonviable pregnancy and ectopic pregnancy were excluded from the study. Results: Overall, the frequency of C-sections in the present study was 30% in primigravida and 70% in multigravida. Majority of the patients (65%) went through elective C-sections while 35% delivered through emergency C-sections, difference between the two is statistically significant (p-value &lt;0.0001). The commonest cause for performing elective C-sections was previous C-sections. Fetal distress was the commonest indication 27.27% for emergency C-sections. Most of the C-sections performed in primigravida were because of fetal distress 23.3% while previous C-sections were the topmost cause in multigravida. Maternal wish is another new indication that accounted for 7.6% of C-sections. Conclusion: The results showed that the incidence of C-sections was higher in multigravida than primigravida. Similarly, the rate of elective C-sections was more than emergency ones. Maternal wish is another rising new indication for C-sections.

Role of Maternal ABO Blood Type on Adverse Obstetric Outcomes

Abstract: This retrospective chart review evaluates the potential role of maternal ABO blood type on various adverse obstetrical outcomes for both mother and neonate, including maternal hypertensive disorders, GDM, fetal growth restriction, clinical chorioamnionitis and other related disease processes. Methods: Delivery records were obtained from the electronic medical record (EMR) for deliveries occurring between 1/1/2020 and 12/31/2022. Data were extracted from nurse entered fields in the EMR during the delivery encounter (blood type, maternal age, body mass index (BMI), gestational age at delivery, quantitative blood loss, mode of delivery, and presence of Category 2 tracing,). Missing data were obtained through chart review. Other variables obtained through chart review included maternal pregnancy history, clinical chorioamnionitis diagnosis, fetal growth restriction, stillbirth, prolonged rupture of membranes, indications for cesarean section, hypertensive disorders of pregnancy, and medical history including chronic hypertension, gestational and pre-gestational diabetes, thrombophilia, bleeding disorder, venous thromboembolism, seizure disorder, cholestasis of pregnancy, and COVID infection. Comparisons between maternal blood type AB vs. all other blood types (group containing blood types A, B, and O) were completed using Student’s t-tests, Mann Whitney U tests, Pearson’s chi-square tests, or Fisher’s Exact tests as statistically appropriate. Comparisons between the 4 individual blood types (AB, A, B, O) were completed using ANOVA, Pearson’s chi-square tests, or Kruskal-Wallace tests as statistically appropriate. Post-hoc multivariate logistic regression was used to examine associations of interest identified on bivariate analysis. Results: A total of 3263 deliveries were reviewed from between 1/1/2020 and 12/31/2022. Of these, 113 patients had blood type AB (3.5%) and 3150 had other blood types (1015 type A, 463 type B, 1672 type O). Patients with blood type AB had statistically higher age than other blood types (31.0 ± 5.2 vs. 29.9 ± 6.1, p=0.046) and lower BMI (31.2 [IQR 7] vs. 33 [IQR 9.5], p =0.009). There were no differences in nulliparity, gestational age at delivery, chronic hypertension, gestational diabetes, cholestasis of pregnancy, quantitative blood loss, postpartum hemorrhage, clinical chorioamnionitis, fetal growth restriction, stillbirth, category 2 tracing, or mode of delivery. Patients with blood type AB had a gestational hypertension rate of 14% compared to 9% in other blood types (p=0.059). This association was further explored in multivariate logistic regression for prediction of gestational hypertension, which showed a statistically significant association for blood type AB vs. other (p=0.032, OR 1.91 (95% CI 1.06-3.43)) when controlling for age (p=0.074, OR 0.98 (95% CI 0.96-1.00)), BMI (p&lt;0.001, OR 1.05 (1.04-1.07)), and gestational age (p=0.041, OR 1.06 (1.00-1.11)). However, patients with blood type AB had a rate of preeclampsia and superimposed preeclampsia of 3.6% compared to 8.9% in other blood types (p=0.05). This, too, was further explored in a regression for prediction of preeclampsia and superimposed preeclampsia, which did not show a statistically significant association for blood type AB vs. other (p=0.089, OR 0.36 (95% CI 0.11-1.17), when controlling for age (p=0.59, OR 0.99 (0.97-1.02)), BMI (p&lt;0.001, OR 1.06 (1.05-1.08)), and gestational age (p&lt;0.001, OR 0.88 (0.86-0.91)). A third regression model on any hypertensive disorder of pregnancy (including gestational hypertension, preeclampsia with or without severe features, eclampsia, and superimposed preeclampsia) did not show a statistically significant association for blood type AB vs. other (p=0.65, OR 1.13 (95% CI 0.66-1.95)) when controlling for age, BMI, and gestational age. Four-way comparisons between the 4 individual blood types (AB, A, B, O) did not show differences in any of the outcomes. Conclusion: Previous investigations have found variable results regarding maternal blood type and adverse obstetrical outcomes including hypertensive disorders, gestational diabetes, and perinatal diseases. A previous study by Burgess et al. found that mothers with type AB blood had an increased risk of developing late onset preeclampsia, while Hentschke et al. found no association between preeclampsia and maternal blood type. Reisig et al. found a significant correlation between type A+ mothers and the development of preeclampsia. This retrospective chart review of 3263 deliveries was performed to further investigate these associations and address this knowledge gap. It has been shown that AB blood type is associated with stimulated antigen response, an increased prothrombotic state and increased disease risk. In this study, maternal AB blood type was found to be associated with gestational hypertension. However, this association was likely due to a Type I error, as no other association with other hypertensive disorders, such as pre-eclampsia, was found to be significant. We found no other statistically significant correlations between maternal blood type and adverse obstetrical outcomes. Although previous studies have demonstrated a potential association between maternal AB blood type and adverse outcomes, our study, with a substantial sample size, did not yield similar results. In conclusion, physicians should not depend on maternal blood type as a reliable indicator of potential obstetrical outcomes or when identifying high-risk mothers.

Comparison of the Adjunctive Effect of Tranexamic Acid and Infusion Oxytocin on Blood Loss at Caesarean Section - A Randomised Study

Background: Postpartum haemorrhage is a major complication at caesarean section. Tranexamic acid and oxytocin infusion have been used for prophylaxis. Aim: To compare the effectiveness of prophylactic adjunctive use of Tranexamic acid and oxytocin infusion at caesarean section to reduce blood loss. Method: A randomised study at ABUTH, Zaria, in which 144 women, scheduled for elective or emergency caesarean section at term, were sequentially randomised into two groups of 72 each. The Tranexamic acid group received 1g intravenous and 500ml of Normal saline as placebo while the oxytocin group received placebo and 500ml of Normal saline containing 20IU of oxytocin after delivery of the neonate. Both adjunctive groups received 10IU Oxytocin as part of AMTSL. Trial registry: PACTR 202004568331645. Ethical approval: ABUTHZ/HREC/D37/2018. Result: There was no significant difference in parity, gestational age and indication for caesarean section in both groups p&lt;0.287, 0.270 and 0.095 respectively. There was no significant difference in primary outcome with mean blood loss 561.06 ± 209.23ml versus 567.78 ± 205.91ml in the Tranexamic acid and oxytocin group respectively, p&lt;0.847. Need for additional uterotonic agent and side effect profile were significantly reduced in the Tranexamic acid group. There was no significant difference in need for blood transfusion and haemodynamic status of parturient in both groups. There was no significant difference in mean blood loss at emergency versus elective caeserean section, 565.83± 205.51ml versus 567.97± 217.42ml respectively, p&lt;0.921.Blood loss in those with 1 previous CS was comparable in both groups 537.75± 209.69ml versus 522.05± 176.43ml respectively, p&lt;0.374, however, for those with 2 or more CS, while there was a clinical (reduction) difference of 80ml in the Tranexamic acid group, it was not statistically significant. 594.55± 0.91ml versus 674.06± 1.99ml respectively, p&lt;0.476. Conclusion: There is comparative adjunctive efficacy of Tranexamic acid and oxytocin infusion at caesarean section. Keywords: Caesarean delivery, Oxytocin infusion, Tranexamic acid, Postpartum haemorrhage

Longitudinal Parallel Compression Suture To Control PPH Due to Placenta Previa &amp; Accreta.

Objective: To determine the efficacy and safety of longitudinal parallel compression sutures to control postpartum haemorrhage (PPH) in placenta previa/accreta patients. Methodology: This cross-sectional study was conducted at Department of obstetrics and gynaecology, Peoples University of Medical &amp; Health Sciences for Women; Nawab shah for a period of six months from 7th June 2023 to 6th Dec 2023, after getting approval from ERB of People University of Medical &amp; Health Science. Sample size achieved through non-probability consecutive sampling. Women fulfilling inclusion criteria were selected from the operation theatre of Obstetrics &amp; Gynaecology, PUMHS Nawabshah. To control life threatening PPH owing to placenta previa (with or without accreta) during caesarean section, longitudinal parallel compression sutures in operating room. Outcome variables observed includes amount of blood loss, number of days stayed in the hospital, need for concurrent procedure, need of hysterectomy, and maternal death. Data was entered and analysed on SPSS 25. Results: The stitch was applied in 31 patients. The technique was effective, and successful as a single procedure in 11 patients (35.43%). 6 patients (19%) needed additional tamponade; 12 patients (38%) also received concurrent uterine artery ligation while 2 needed ovarian artery ligation. Despite concurrent procedure 3 patients ended up for hysterectomy (9.1%). The most common indication of caesarean section was placenta previa (51%), mostly done at a gestational age of 37 weeks ± 1.84 standard deviation. Mean age of the patient was 29 years. Estimated blood loss was more than 1.5 litre as seen in 22.6% of the patients and 71.6% patients need blood transfusion. Uterine atony was a common cause of PPH (51%). 51.6% of patients discharged within 3 days of surgery. Two patients expired. Conclusion: The innovative suture techniques have shown promise in improving surgical outcomes in resource-constrained environments, especially in developing countries. This effectiveness can help bridge the gap between limited resources and the need for quality surgical care. Key words: PPH, Uterine Compression Suture, Placenta Previa, Placenta Accreta.

External cephalic version - single-center experience.

External cephalic version (ECV) is an alternative to caesarean section for abnormal fetal position. ECV is recommended by the most important scientific committees in the world. ECV complications are rare and occur in 6.1% of cases, however severe complications requiring urgent caesarean section are found in less than 0.4%. Our aim was to demonstrate the effectiveness and safety of ECV and to present our own experience with the procedure of ECV. ECV was performed on 62 patients (32 nulliparas and 30 multiparas). Qualification criteria included: singleton gestation, gestational age > 36 + 6, longitudinal pelvic lie, no uterine contractions, intact membranes. Indications for immediate cesarean section within 24 hours of ECV were considered a procedural complication. In patients with complications, the condition of the newborn was checked according to the APGAR score and the day of discharge of the mother and child from the maternity ward was analyzed. ECV finished successfully in 66.1% (nulliparas 56.2% and multiparas 76.7%). Patients with a successful ECV were significantly older and had higher median gestational age. ECV was more often successful when placenta was located on the posteriori wall. In our patients, there were 4 cases of complications requiring delivery at the time of ECV. No serious consequences associated with increased maternal or neonatal morbidity or mortality were reported. ECV seems to be a safe alternative for women wishing to deliver vaginally, as this procedure does not increase the risk of adverse obstetric outcomes.

Evaluation of Maternal and Perinatal Outcomes in Pregnancy with Preeclampsia at Aljala Maternity Hospital

Hypertensive disorders of pregnancy (HDP) accounts for 18% of maternal deaths worldwide, with an estimated number of about 62, 000–77, 000 deaths occur each year. The current study aimed to assess maternal and perinatal outcomes of pregnancies complicated by hypertension in Aljala Maternity Hospital. A retrospective, descriptive, case series analysis for four hundred patients was done on the outcome of hypertensive disorder among pregnant women who admitted and were managed at Aljala teaching hospital with preeclampsia during the years 2019 and 2020. Demographic data involving age, parity, gestational week, clinical and laboratory findings were recorded from the medical files. Additionally, delivery route, indications of cesarean section, fetal and maternal complications were determined. The current finding reported high prevalence of perinatal and maternal mortality among pregnant women with preeclampsia. Moreover, other severe maternal and perinatal complications such as Hemolysis Elevated Liver Enzyme Platelet (HELLP) syndrome, placental abruption, eclamptic fits, as well as low birth weight were also commonly reported. The current study showed early onset of preeclampsia was associated with increased risk of developing adverse maternal-fetal/neonatal outcomes compared to late-onset after 36 weeks. Our findings call for special consideration and close surveillance of those women with early-onset diseases.

IJCM_4A: Factors associated with Emergency Caesarean Section in Tertiary Care Hospitals in Mangalore– A Case-Control Study

Background: Maternity hospitals everywhere are seeing a rise in the trend of Caesarean deliveries, the indications for which are varied and could be maternal, fetal or fetomaternal. The objective of the study was to find out the factors associated with the indications for emergency Caesarean sections. Methodology: Retrospective case-control study conducted in Kasturba Medical College Hospital, Attavar and Govt. Lady Goschen Hospital, Mangalore, among women who underwent caesarean sections as cases, and equal number of age matched women who underwent normal deliveries as controls, a total sample size of 70, during the study period 12th April 2016 to 22nd April 2016. A questionnaire was used to collect details including the social- demographic details, antenatal history, and indications for caesarean section. Results: The study showed that 37.1% of women who underwent emergency LSCS were ≤25 years, 34.3% were between 26-30 years, and 28.6% were ≥31 years. Regarding occupation 88.6%of our cases did non strenuous work whereas 11.4% did strenuous work(manual labourer). 20% of our cases were vegetarians and 80% consumed a mixed diet. 71.4% cases were primigravids and 28.6% were non primis. Regarding antenatal visits 85.7% who underwent emergency LSCS made regular antenatal visits and 14.3% were irregular. Conclusion: Among the women that underwent full term vaginal delivery (FTVD), it was observed that they did moderate physical work. Older women (above 30 years) were observed to have undergone emergency LSCS rather than vaginal deliveries. It was seen that most of the women who had a full-term vaginal delivery consumed a mixed diet. Those who underwent emergency LSCS were observed to be mostly primigravida and primipara.

A case of vaginal varicosities without rupture after vaginal delivery

HIGHLIGHTS Vaginal varicosities are prone to happen in pregnant women with unspecific causes and multifactorial. The mode of delivery in a pregnant woman with vaginal varicosities is still unknown, but it is not an indication of caesarean section. ABSTRACT Objective: Vaginal varicose is a rare condition characterized by dilated veins in the labia majora, labia minora, and vagina. This case report reported a woman with vaginal varicose who experienced labor without any delivery complications. Case Report: The patient, a 29-year-old woman, gravida 3, para 2, presented with discomfort and swelling in the vagina at 32 weeks of gestational age. Despite reaching 39 weeks of gestation, the vaginal varicosities remained stable and painless. She had no prior history of varicose veins, hypertension, blood abnormalities, malignancy, or contraception usage. Physical examination revealed mild varicosities in the labium and significantly swollen varicosities protruding toward the vaginal introitus. Interestingly, a small varicose vein was also noted on her right leg, previously unnoticed by the patient. At 39 weeks pregnant, she experienced spontaneous vaginal delivery without complications. During the third stage of labor, the vaginal varicosities decreased in size, and no rupture occurred. The newborn, a healthy baby boy weighing 2961 grams and measuring 48 cm, was delivered vaginally. Despite a second-degree perineal tear, blood loss was minimal, and no complications nor rupture arose from the varicose veins. Conclusion: Vaginal varicosities are rare, primarily occurring in multigravida pregnant women between 12 and 26 weeks of gestation. This case highlights that cesarean section is not necessarily indicated in pregnant women with vaginal varicosities. The successful vaginal delivery in this instance resulted in no varicose vein rupture, controlled bleeding, and regression of vaginal varicosities postpartum.

FEATURES OF THE PHYSIOLOGY OF THE POSTPARTUM PERIOD AFTER CAESAREAN SECTION

The main principle of perinatal obstetrics is to ensure the health of the mother, fetus and newborn, which in some cases requires quick and gentle delivery. Therefore, during the last decades, cesarean section (CS) in obstetric practice has become a tool that allows you to preserve the health of both the mother and the child.&#x0D; Despite its wide distribution, CS is classified as a category of complex operations with a high frequency of postoperative complications (3.3%-54.4%), which are associated with the intervention technique, obstetric and neonatal reasons. Potential structural and functional complications include: the risk of pulmonary, gastrointestinal and vascular complications; postoperative pain and discomfort; pelvic organ prolapse; posture change; pelvic floor dysfunction; weakness of the abdominal wall; diastasis of rectus abdominis muscles; umbilical hernia; general functional limitations.&#x0D; Scientific progress in medicine, social and cultural changes have led to fundamental transformations in the attitude to CS among women and doctors. In fact, the consensus regarding indications for caesarean section has changed in many countries, now including psychosocial factors such as anxiety about childbirth or the mother's desire for caesarean section in the absence of any medical indication.&#x0D; The postpartum period is a critical, but often overlooked, period in the lives of new parents. According to the WHO, the majority of maternal and newborn deaths occur during this period, so proper management and care of parents and newborns is vitally important.&#x0D; The postpartum period is usually divided into three separate but continuous phases: acute phase (early postpartum period) - 24 hours immediately after childbirth; subacute phase (late postpartum period): can last 2-6 weeks after childbirth; late phase - can last from 6 weeks to 6 months after childbirth.&#x0D; The postpartum period is characterized by a wide range of new states of women's life and increased sensitivity to external factors. The whole range of postnatal changes can be considered as an integrative combination of psychological, physiological and endocrine factors that affect the physical and mental activity of women, as well as determine their relationship with the child.&#x0D; Therefore, a caesarean section should be performed according to indications with a mandatory justification.&#x0D; The presence of a postoperative scar in women who underwent an abdominal delivery causes changes in the postpartum period in the form of a specific limitation of mobility during its formation. This aspect is all the more important from the point of view of the onset of future pregnancies, which requires the formation of a full-fledged elastic strong scar on the uterus and soft tissues.&#x0D; The formation of a scar in the postpartum period, in connection with the need for care and feeding of the child, changes as a result of sleep and rest regimes, additionally increases the metabolic, physical, psycho-emotional load, which causes pressure on the adaptive capabilities of the regulatory systems of the woman's body against the background of reconstruction and recovery structural and hormonal components.&#x0D; A woman's condition directly affects her ability to care for and raise a child, return to work and social activity, as well as the quality of life, both personally and within the framework of the environment. Therefore, certain recovery measures are necessary for their normalization as soon as possible.

Lessons Learned From Three Patients Who Underwent Cesarean Section and Cardiac Valvular Surgery Simultaneously: Anesthesiologists’ Perspective

Background: Cardiac valvular disease constitutes a challenge during pregnancy. Herein, we present our experience with three patients who underwent caesarean section and cardiac valvular surgery simultaneously. The purpose of this case series was to outline the clinical characteristics and to highlight the surgical/anesthesiologic pitfalls to be considered in patients who will undergo cardiac valvular surgery and caesarean section simultaneously. Methods: This retrospective case series was implemented using data extracted from the medical files of three patients who underwent cardiac valvular surgery and caesarean section in the obstetrics and gynecology and cardiovascular surgery departments of our tertiary care center. Demographic data, history, echocardiographic findings, surgical and anesthesiologic techniques as well as perioperative information and therapeutic outcomes were recorded. Results: Three pregnant women with an average age of 33.67 years were diagnosed with various cardiac valvular pathologies on the 3rd trimester. Owing to their diminished cardiac reserves and clear indications for cesarean section, the patients underwent cardiac valvular surgery subsequent to the cesarean section. Procedures were completed successfully on all patients and mothers and infants were discharged after a maternal follow-up in intensive care unit. Conclusion: We suggest that cardiac valve surgery can be performed simultaneously just after cesarean section in selected cases. Risks and benefits must be analyzed well prior to the decision making for the absolute necessity of the invasive procedure. Close collaboration between disciplines, well equipped referral centers, trained personnel and increased awareness on possible complications are the key points for successful surgical management of pregnant women with cardiac valve disease.

Obstetric Outcome in Patients with Previous Abdominal Myomectomy at a Tertiary Hospital in South-South Nigeria

Background: Abdominal myomectomy refers to the surgical removal of fibroids from the uterus through an abdominal incision. It is one of the treatment options for uterine fibroids. Women who had this form of treatment may be faced with increased risks and complications during future pregnancies and deliveries. Aim: To assess the obstetric risk and delivery outcome of pregnancies achieved after abdominal myomectomy. Methodology: This was a retrospective study of pregnancy outcome in women who had abdominal myomectomy at University of Port Harcourt Teaching Hospital (UPTH) from 2018 to 2022. The case records of the patients were retrieved, and data on socio-demographic characteristics, mode of delivery, obstetric complications, and foetal outcome was extracted and analysed using SPSS version 25. Results: There were 7,602 antenatal clinic attendees during the study period, out of which 83 of the women had previous myomectomy and were delivered in UPTH. This accounted for 1.1% of booked patients who attended antenatal care and delivered at the hospital. Seventy-two case notes were retrieved, giving a case retrieval rate of 86.7%. The mean age was 34.89 ± 4.27 years (range from 18 to 47 years). The total Live birth post myomectomy was 56 (77.8%). There were 14 (19.4%) miscarriages and 2 (2.8) stillbirths. Patients that conceived spontaneously were 61 (84.7%), while 11 (15.3%) had in-vitro fertilization (IVF). Caesarean section was used in 67 (93.1%) of deliveries with elective caesarean section accounting for 45 (62.5%) of the deliveries. The commonest indication for caesarean section was previous myomectomy with breached endometrium in 53 (79.1%) cases. Forty-one (56.9%) of the deliveries occurred at 38-40 weeks of gestation. Conclusion: Obstetric outcome after abdominal myomectomies was good with high live birth rate and no maternal mortality recorded. Women who had abdominal myomectomy should be counselled to attend antenatal care and deliver in adequately equipped centres with skilled personnel to avert adverse pregnancy outcomes.

Induction of Labour in a District Hospital of Rural Nepal: A Descriptive Cross-sectional Study

Introduction: Induction of labour, a medical intervention before spontaneous onset, is employed when the risk of continuing pregnancy is elevated. Common indications include intrauterine growth restriction, preeclampsia, gestational diabetes, placental abnormalities, prelabor rupture of membranes, post-term pregnancy, and intrauterine foetal demise. The objective of this study was to find out the prevalence of induction of labour in a rural setting in Nepal.Methods: We conducted a descriptive cross-sectional study in the District Hospital Tehrathum using patients’ record files from 14 January 2021 to 14 January 2023. Ethical approval was obtained from Nepal Health Research Council. Demographic variables were collected along with maternal outcomes which include indication of induction of labour, mode of delivery, indication of lower segment caesarean section and foetal outcomes include APGAR score at one and five minutes, birthweight and liquor colour. A total population sampling method was used in the study and 95% confidence Interval was used to calculate the point estimate. Results: Among 640 deliveries during the study period 118 (18.43%) (15.43- 21.43, 95% Confidence Interval) underwent induction of labour. Sixty-three (53.4%) of the 118 patients who underwent induction of labour were primigravida.Conclusions: The prevalence of induction of labour was comparable with previous studies. Neonatal outcome, rate of vaginal and lower segment C-section deliveries after induction of labour using misoprostol is comparable with other studies.

Echographic Screening for Fetal Malformations at the Gynecological and Obstetric Clinic of the Aristide Le Dantec Hospital: Review from 2016 to 2018

Introduction: Congenital malformations affect around 3% to 4% of live births and 20% of stillbirths. They represent 20 to 30% of the causes of infant mortality in the countries of the European Community. It is estimated that 5 to 10% of malformations are due to exogenous or environmental causes and 12 to 30% to genetic or endogenous causes (gene mutations or chromosomal anomalies). In almost 60% of cases, the actual origin of the malformation remains unknown. Nevertheless, the origin of these anomalies is still being researched, and numerous diagnostic tools are available to practitioners to improve antenatal screening and pregnancy monitoring. However, obstetric ultrasound remains the primary tool for antenatal screening and monitoring of congenital malformations. Methodology: Our main objective was to evaluate the practice of ultrasound screening for foetal malformations at the Gynaecology and Obstetrics Clinic at Hopital Aristide Le Dantec from 1 February 2016 to 31 December 2018. We conducted a retrospective study of ultrasound screening for foetal malformations. Results: At the end of our study, 869 obstetric ultrasounds met our inclusion criteria. We had 837 singleton pregnancies (96.3%), 31 twin pregnancies (3.6%) and 1 trimellar pregnancy (0.1%). We noted 35 cases of foetal malformations, an incidence of 4.02%. All cases of malformations were diagnosed in singleton pregnancies. The average age of the patients was 29 years, with extremes of 18 and 45 years. Primiparous women were the most represented in our study (62.5%). The majority of patients were from Dakar. A history of recurrent miscarriage was found in 7 patients (20%) and there was one case of fetal death in utero during the previous pregnancy. There was no family history of malformations. Consanguinity was found in 11 cases (31.4%). Only 2 patients were found to have taken medication, one for insulin and the other for an unspecified drug. There was no evidence of toxic intake. Fetal malformations were observed in the 3rd trimester in 23 cases (42.9%). There were 11 cases in the 2nd trimester (31.4%) and only 1 case in the 1st trimester. Cranioencephalic malformations were detected in almost half of the cases (42.8%), i.e. 15 cases. There were 8 cases of polymalformative syndromes, i.e. 22.8%. Digestive malformations were represented in 3 cases, i.e. 8.6%, as were cardiac malformations in 3 cases. Pulmonary malformations and limb malformations accounted for 5.7% and 2 cases each. Renal malformations and orofacial malformations also accounted for 1 case each, 2.9% respectively. Among the 15 cases of malformations of the nervous system, ventricular dilatation ranked first with 10 cases representing 66.6%, followed by anencephaly and cystic hygroma with 2 cases each representing 13.3% and finally dolichocephaly with 1 case representing 6.7%. We found 8 different cases of polymalformative syndromes. These syndromes were labelled in 2 cases and unlabelled in the 6 others. There was 1 case of trisomy 21 and 1 case of trisomy 13. The other cases of polymalformative syndromes were not clearly labelled. A combination of cerebral, $cardiac and/or renal malformations were reported. Digestive malformations were noted in 3 cases (8.6%), including 2 dilatations of the coves (megacolon) and 1 case of omphalocele. Pericarditis, atrial septal defect and transposition of the great vessels were the cardiac malformations found in a total of 3 cases (8.6%). Two cases of achondroplasia were found in our series (5.7%). They were all associated with oligohydramnios. There were 2 cases of pulmonary hypoplasia (5.7%). These were associated with anamnios and a medullary syndrome in one of the cases. Cleft lip and palate and polycystic kidney disease were present in one case each (2.9%). The pregnancy resulted in vaginal delivery in 21 cases (60%), caesarean section in 13 cases (37.1%) and in 1 case the mode of delivery was not specified. The main indication for Caesarean section was hydrocephalus (61.5%). The anomaly and the type of malformation were announced in 85.5% of cases. A referral for fetal ultrasound was suggested in 5.7% of patients and fetal MRI in 2.9%. Concordance between antenatal and postnatal diagnosis was achieved in 18 cases (51.4%). The pregnancy resulted in vaginal delivery in 21 cases (60%), caesarean section in 13 cases (37.1%) and in 1 case the mode of delivery was not specified. The main indication for Caesarean section was hydrocephalus (61.5%). The anomaly and the type of malformation were announced in 85.5% of cases. A referral for fetal ultrasound was suggested in 5.7% of patients and fetal MRI in 2.9%. Concordance between antenatal and postnatal diagnosis was achieved in 18 cases (51.4%). Neonatal mortality accounted for 62.9% of the series, with 22 cases. Conclusion: Fetal malformations were detected with a concordance of 51.4% between antenatal and postnatal diagnosis. Neonatal mortality was high. A major preoccupation should be the strengthening of cytogenetic diagnosis and management resources, and raising awareness of the origins of congenital malformations.

Maternal Morbidity Associated With A Successful Versus Failed Trial of Labour After A Previous Caesarean Section

Objective: To compare the maternal morbidity associated with a successful trial of labour after the previous scar versus a failed trial of labour after the previous scar and ending in repeat Caesarean section. Study Design: Cross-sectional study. Place and Duration of Study: Department of Gynaecology and Obstetrics, Pak-Emirates Military Hospital, Rawalpindi Pakistan, from Jun to Dec 2022. Methodology: A total of six hundred and ten (n=610) patients were in the study. The variables studied while observing the outcome included indication of Caesarean section in the previous delivery, birth weight of the baby, overall outcome and post-operative maternal complications. Results: The mean age of the participating patients was 24.44±3.89 years. Of the 610 patients, 278(45.6%) delivered successfully via vaginal delivery after a previous Caesarean section, while 332(54.4%) had to be delivered again via repeated Caesarean section. Overall outcome in both groups revealed 331(99.7%) patients were delivered by Caesarean section, with 01(0.3%) patients landing in a ruptured uterus in the Caesarean Section Group. Conclusion: Previous history of normal vaginal delivery, increased parity and birth weight less than 3 kg have a better chance of a successful Vaginal Birth after a Caesarean section in selected patients resulting in fewer complications and decreasing the overall Caesarean section rate.

The Incidence and Indications of Caesarean Sections in King George Hospital (KGH), Visakhapatnam

The Incidence and Indications of Caesarean Sections in King George Hospital (KGH), Visakhapatnam

A Retrospective Study Analyzing the Incidence of Urine Incontinence after Cesarean Section Delivery in Comparison with Vaginal Delivery

Introduction: Urine incontinence is the involuntary leakage of urine. Its actual prevalence is underestimated. There is a general belief that vaginal delivery is a major risk. Elective cesarean delivery is increasing worldwide; one reason is to protect against pelvic floor disorders, including urine incontinence. Previous studies included small samples with controversial results. This study aimed to compare the risk of urine incontinence in women who had cesarean delivery with those who had vaginal delivery. Methods: It was a retrospective study on 1751 women delivered in a university hospital over a 5- year period. Data collected on number of deliveries, age at first and last delivery, mode of each delivery, gestational age, birth weight, indication of cesarean section, induction of labor, episiotomy, perineal tears, smoking, chronic cough, chronic constipation, presence and severity of urine incontinence using ICIQ score. Patients were categorized into 2 groups: all cesarean section deliveries and at least one vaginal delivery. Results: A total of 600 respondents delivered only by cesarean section, and 1151 had at least one vaginal delivery. Urine incontinence prevalence in the cesarean group was 5.8%, and 6.9% in the vaginal group. Age, perineal tear, chronic cough, and chronic constipation were found to be significantly associated with urinary incontinence. After adjusting for all other variables, vaginal delivery was not found to be significantly associated with incontinence compared to cesarean. Conclusion: Vaginal and cesarean deliveries have a comparable incidence of urinary incontinence. It is difficult to get a firm conclusion on whether cesarean is protective. Chronic constipation and cough are important factors regardless of delivery mode.

Assessment of maternal and fetal outcomes according to induction methods following negative oxytocin challenge test

Background/Aim: There is insufficient information about how long fetal well-being will last after a negative oxytocin challenge test (OCT) and the factors affecting this process. We aim to evaluate maternal and perinatal outcomes in high-risk patients who had negative OCTs and to investigate the effects of methods of induction on the development of fetal distress. Methods: The study was designed as a retrospective cohort study. Data of patients who were hospitalized in the perinatal intensive care unit due to high-risk pregnancies between January 2016 and December 2016 were reviewed retrospectively. The patient’s gestational age, gravidity, parity, and body mass index (BMI), risk factors leading to the OCT, labor induction methods used following a negative OCT, time from negative OCT to delivery, mode of delivery, and indications for cesarean section were recorded. In addition, data regarding fetal sex, birth weight, birth height, labor complications, Apgar scores at minutes 1 and 5, admission to the neonatal intensive care unit (NICU), indications for NICU admission, length of NICU stay, and stillbirth were also recorded. Results: OCT was performed on 551 patients and was negative in 447 patients. Among patients with a negative OCT, labor induction was preferred in 427 (95.5%) patients. When fetal distress development was assessed according to the induction method used following a negative OCT, fetal distress developed in 9.1% of 427 patients who underwent labor induction. Conclusion: When outcomes were considered in pregnant women with a negative OCT, it was observed that there were no fetal deaths and a limited number of newborns with low Apgar scores. Further randomized studies are needed to draw definitive conclusions.

Outcomes of Trial of Labor after a Cesarean Section in Bomet County, Kenya

Trial of labor after cesarean section (TOLAC) is recommended for women with one prior cesarean section. However, TOLAC positive outcomes depend on selecting candidates to achieve higher success rates. Most available TOLAC data to inform patient selection originates from developed countries, which limits a patient-centered TOLAC practice in low-resource settings. Thus, we used a prospective observational cross-sectional approach to assess the success rate of TOLAC and establish the maternal and fetal factors associated with successful TOLAC in 170 women with one previous scar at two referral hospitals in Bomet County, a low-resource setting in Kenya. The primary maternal and neonatal outcomes were compared between those who had a vaginal birth after a cesarean section (VBAC) and those who had an emergency repeat cesarean section (ERCS) following a failed TOLAC between October 2022 and June 2023. The TOLAC success rate was 48.2% with the most common indication for emergency repeat cesarean section being failure to progress (34.1%). Factors associated with successful TOLAC included inter-delivery interval &gt;60 months (p-0.044), and parity 2-4 (p- &lt;0.001). Breech presentation and non-reassuring fetal status (NRFS) as indications for previous cesarean section, were associated with a successful VBAC (p-&lt; 0.001, 0.033). In contrast, a birth weight of &gt;3500 g was associated with an increased risk of ERCS. Moreover, a failed TOLAC was associated with a prolonged (&gt;4 days) hospital stay (p-0.012). Our findings suggest that with proper patient selection, TOLAC remains a viable option with better outcomes if successful. However, TOLAC candidates should be evaluated based on the contextual factors of a given setting, hence careful patient selection is recommended to improve outcomes associated with TOLAC.

Quelle réponse apporter à un refus obstiné de soins lors de l’accouchement ?

Our team was confronted with a situation of stubborn refusal of care, including the indication of a cesarean section for an adult patient able to express her wishes. This refusal was formulated during pregnancy follow-up, during the discussion of the birth plan and during delivery, the patient having accepted the indication of a possible emergency cesarean section under general anesthesia only in the occurrence of severe fetal heart rate abnormalities. The impasse forced caregivers to violate the rules of good clinical practice, which indicated the performance of a cesarean section, and to wait for a complication to arise in order to be able to act, taking the risk of intervening too late. This situation has led to direct risks to the health of the mother and the unborn child, without putting the life of either of them in imminent danger. Finally, the time devoted to this patient in a tense organization was to the detriment of the care of other patients.