Indication For Caesarean Section Research Articles

Assessment of Clinical Indications for Caesarean Section in Mosul City Hospitals: A Cross-Sectional Study

Background: Caesarean section is traditionally done when a vaginal delivery would put the mother or fetus's life at risk. Knowing the indications of the caesarean section will help to have an impression of this common type of the obstetric procedures. The aim of the current study was to examine the indications of caesarean sections which are undertaken in Mosul city hospitals. Methods: A cross-sectional study was done at eight hospitals in Mosul city and a sample of 671 women who were delivered by caesarean section was included in this study. The necessary agreement was obtained from all the participants in the sample. Study period: the study was done during the period from 15th November 2019 to 15th April 2020. The information was taken by direct interview with the women who were delivered by caesarean section and from their hospital case sheets. Results: Primary caesarean section was reported in 45.2% of cases followed by previous two or more CS in 32.3% and those with previous one caesarean section with other causes 22.5% with a very highly statistically significant difference (P=0.001). Fetal distress was the indication for primary caesarean section in one-quarter of cases 25.4% with a very highly statistically significant difference (P=0.000) from other causes. Maternal request constituted 11.5% of indications among the participant women and it constituted one-quarter of causes among women with previous one caesarean section (P=0.000). Conclusions and recommendations: Primary caesarean section constituted the highest number among caesarean section indications in the current study, followed by previous two or more caesarean section and then previous caesarean section with other causes. Fetal distress was the highest indication in primary caesarean section cases. The study recommends to improve health education to the mother about the risk of caesarean section and possibility of normal delivery after primary caesarean section.

Local Versus Systemic Use of Tranexamic Acid in Elective Cesarean Section

Abstract Background: Obstetric hemorrhage remains one of the major determinants of maternal death in both developed and developing countries. Because of its weight as a leading cause of maternal mortality and morbidity. Hemostatic drugs are not usually used as first-line treatment in post-partum hemor-rhage (PPH). It was authenticated that extensive tissue injury can direct the hemostatic equilibrium toward increased fibri-nolysis, leading to coagulopathy and bleeding. Antifibrinolytic drugs, named tranexamic acid (TXA) have been recognized to decrease blood loss and transfusion needs in various elective surgeries. Aim of Study: Evaluating the role of adjunctive IV Tran-examic acid versus topical Tranexamic acid infusion of the placental bed to prevent the postpartum hemorrhage. Patients and Method: It was a randomized clinical trial that extended from January 2019 to January 2020 and was done at Mansoura University Hospital, Obstetrics and Gyne-cology Department and it included a total of 164 pregnant subjects planning for cesarean section who were randomly divided into two groups; the initial group included cases who were subjected to local tranexamic acid administration (2gm), and the other one included cases who were commenced on the intravenous form (1gm). Before operation, all subjects were subjected to complete history taking, fulllaboratory investigations, detailed obstetric examination, and pelviab-dominal ultrasound. Cesarean section was performed in all cases using the standard procedure. Results: The mean age of the included cases was 35.3 and 33.89 years in the local and systemic groups respectively. There was no significant difference between the two groups regarding parity, number of gestations, the indication of cesarean section and the mean operative time. Blood loss was significantly increased in the systemic group versus local group (p < 0.001), hemoglobin levels showed significant de-crease in the systemic group. The change in both hemoglobin and hematocrit levels was significantly higher in the systemic group (p < 0.001). Conclusion: It is apparent that topical administration of TXA is associated with more effective to decrease blood lossv and causes less change in hematological parameters compared to its intravenous administration.

Ogilvie Syndrome Following Caesarean Section: A Case Report

Background. Ogilvie syndrome is a rare postpartum complication. It is characterized by an acute colonic pseudo-obstruction which occurs in the absence of a mechanical cause. Early detection of the diagnosis is essential to avoid cecal perforation.&#x0D; Case report. We report a case of Ogilvie syndrome following caesarean section in a 39-year-old woman (gravida 2, para 2) with a history of secondary infertility 10 years ago due to tubal stenosis and subserous fibroma, which led to the indication for cesarean section in second pregnancy at 39 weeks of gestation. Three days after cesarean section, the patient presented with significant abdominal distension and tenderness, vomiting, weakness, and nausea; an abdominal X-ray showed cecal distension. Abdominal computed tomography scan with intravenous contrast revealed distension of the ascending and transverse colon with air-fluid levels but without transitional mechanical obstruction. The patient was successfully treated.&#x0D; Conclusions. Ogilvie syndrome is a rare but serious complication that should be considered in fit young patients who present with pain, severe abdominal distension and failure to pass flatus after caesarean section.

The course of pregnancy and childbirth in women with a scar on the uterus after myomectomy using endoscopic technologies

The objective: to study the features of the restoration of reproductive function, the course of pregnancy and childbirth in women with a scar on the uterus after myomectomy using endoscopic technologies.Materials and methods. The study was conducted in three stages. At the first stage, the course of the postoperative period after myomectomy in 180 women of reproductive age was analyzed, of which 80 patients (1 group) underwent laparotomy myomectomy with suturing of the bed with two-row synthetic sutures; 50 patients (2 group) – laparoscopic myomectomy with suturing of the bed with two-row synthetic sutures and 50 women (3 group) – laparoscopic myomectomy with bipolar coagulation of the bed. In the second stage, 6 months after surgery, all patients were examined to rule out signs of inferiority of the myometrial scar and predict the possibility of natural childbirth. The diagnostic complex included ultrasound (US), hysteroscopy and hysterosalpingography. During the third stage, the course of pregnancy and the method of delivery in 115 (63,8%) women out of 180 in whom the desired pregnancy occurred in the range from 6 months to 5 years were analyzed.Results. Analysis of the postoperative period showed that the use of electrocoagulation worsens its course. So, in 12% of patients in group 3, subfebrile condition persisted for 6 days, which is 3,2 times more than in 1, and 3 times more than in 2 groups. ESR and leukocyte index were also significantly higher in 3 group. Against the background of an increase in leukocytes in patients of 3 group, unfavorable scar formation was also observed, which manifested itself in the form of a larger relative area of the vascular component. At the border of the myometrium and scar after myomectomy, leukocyte infiltrates were found in 18,2% of patients in 1 group and in 30,7% in 2 group, and after coagulation of the bed – in 100%. Therefore, it is advisable to plan natural childbirth in patients after myomectomy with suturing of the uterine wall, regardless of surgical access. However, there are some advantages of laparoscopic access with coagulation of the bed – the shortest duration of the operation and less intraoperative blood loss.After pre-pregnancy complex of diagnostic manipulations in 47 pregnant women out of 115 revealed signs of inferiority of the scar on the uterus after myomectomy, which was an indication for routine caesarean section (CS). But the frequency of detection of a defective scar was different in each group: in 1 groups and 2, the planned CS was performed for every fourth woman, in 3 group - for every second. These data indicate an adverse effect of laparoscopic coagulation of the fibroid bed on the healing of the myometrial scar. In the structure of indications for emergency CS in all comparative groups prevailed anomalies of labor, and in 3 group this fact was entirely associated with the threat of uterine rupture and scarring, while in parturients 1 and 2 groups - almost 2 times less often.In 35 patients with a scar on the uterus after myomectomy there were spontaneous preterm births by live full-term infants without asphyxia, of which 18 gave birth to group 1, 15 – 2 group, and only 2 women from 3 group gave birth per vias naturalis.Conclusions. The method of carrying out myomectomy does not affect the onset and course of pregnancy in the future, but it does matter on the ability of independent childbirth. In women who have not completed the reproductive program, it is necessary to suture the walls of the uterus during myomectomy, regardless of access. Electrocoagulation of the bed after removal of fibroids contributes to an increase in the frequency of threatening uterine rupture by 2 times. The decisive role in the management of childbirth with a myometrial scar is played not by the thickness of the lower segment, but by the presence of clinical manifestations of its failure (local soreness of the lower segment of the uterus, spotting from the genital tract, fetal hypoxia).

A three year review of twin deliveries in a specialist hospital in North-Western Nigeria

Background: Although the frequency of twin pregnancies varies from one ethnic group to another, there has been a general trend toward an increase recently. Maternal and perinatal mortality are higher in twin than singleton pregnancies. Most studies on twinning had been done in university teaching hospitals where conditions are different from what is seen in secondary-care health institutions where this study was done Objectives: To determine the incidence, mode of delivery and maternal and perinatal outcomes of twin deliveries at a secondary-level hospital in North-Western Nigeria. Methodology: This was a descriptive study of 96 twin deliveries over a three-year period between May 2013 and April 2016 at a secondary-level hospital with access to specialist obstetricians and paediatricians. Result: There were 4,567 deliveries, with 101 twin deliveries, an incidence of 2.2% or 1 in 45 deliveries. The mean maternal age and parity were 26.4 years and 3.2 respectively. The mean gestational age at delivery was 35.9 weeks, with a mean birth weight of 2.18kg and 2.01kg for the first and second twins respectively. Male twins constituted 53.2% of twin births. The common presentations of the twins were cephalic–cephalic (64.6%), cephalic–breech (16.7%) and breech–breech (6.3%). Mode of deliveries were vertex vaginal (77.1%) and caesarean (14.6%). Breech presentation of the leading twin was the commonest indication for caesarean section (57.1%). Anaemia in pregnancy (16.7%) was the commonest maternal complication, while prematurity was the leading cause of perinatal mortality. Conclusion: Preterm delivery, malpresentation, operative delivery and maternal anaemia in pregnancy were commonly seen in association with twin pregnancy in this cohort of patients.

Management of prolonged first stage of labour in a low-resource setting: lessons learnt from rural Malawi

BackgroundCaesarean sections without medical indication cause substantial maternal and perinatal ill-health, particularly in low-income countries where surgery is often less safe. In presence of adequate labour monitoring and by appropriate use of evidence-based interventions for prolonged first stage of labour, unnecessary caesarean sections can be avoided. We aim to describe the incidence of prolonged first stage of labour and the use of amniotomy and augmentation with oxytocin in a low-resource setting in Malawi.MethodsRetrospective analysis of medical records and partographs of all women who gave birth in 2015 and 2016 in a rural mission hospital in Malawi. Primary outcomes were incidence of prolonged first stage of labour based on partograph tracings, caesarean section indications and utilization of amniotomy and oxytocin augmentation.ResultsOut of 3246 women who gave birth in the study period, 178 (5.2%) crossed the action line in the first stage of labour, of whom 21 (11.8%) received oxytocin to augment labour. In total, 645 women gave birth by caesarean section, of whom 241 (37.4%) with an indication ‘prolonged first stage of labour’. Only 113 (46.9%) of them crossed the action line and in 71/241 (29.5%) membranes were still intact at the start of caesarean section. Excluding the 60 women with prior caesarean sections, 14/181 (7.7%) received oxytocin prior to caesarean section for augmentation of labour.ConclusionThe diagnosis prolonged first stage of labour was often made without being evident from labour tracings and two basic obstetric interventions to prevent caesarean section, amniotomy and labour augmentation with oxytocin, were underused.

Análise e monitoramento das taxas de cesárea no Brasil segundo a classificação de Robson

Objetivo: Discorrer o que a literatura apresenta sobre os fatores de riscos obstétricos das mulheres submetidas à cesárea, segundo a Classificação de Robson. Método: Trata-se, de uma revisão bibliográfica do método revisão integrativa da literatura, com abordagem qualitativa, realizado entre setembro de 2020 a fevereiro de 2021, por meio da busca de artigos indexados nas seguintes bases de dados: Scielo (Scientific Eletronic Library Online), BVS (Biblioteca Virtual em Saúde), Google Scholar, PubMed (National Center for Biotechnology Information), Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde), Revistas de Enfermagem. Os critérios de inclusão para a seleção dos conteúdos foram, artigos na linguagem portuguesa, inglesa e espanhola. Publicados nos referidos bancos de dados compreendendo os anos de 2011 a 2021. Como critérios de exclusão, não foram considerados artigos mediante a recompensação monetária, incompletos, duplicados e não convergentes com este estudo. Resultados: Este estudo ressalta que, a cesárea é um procedimento que possui mais risco para as mulheres, quando comparado ao parto normal, posto isso, em decorrência dos fatores de riscos para a mulher e recém nascidos, a cesariana realizada sem as existentes indicações médicas tem sido alvo de estudos em todo o mundo. Sendo assim, é necessário identificar a real indicação do parto cesáreo sem que isto ocorra somente por comodidade médica. Conclusão: Evidenciou-se no estudo, que é a utilização da Classificação de Robson mostra-se extremamente útil e pode auxiliar em programas para monitorar as indicações de cesáreas, com probabilidade de redução das taxas e mortalidade materna.

Obstetric anal sphincter injury and anal incontinence.

The aim of our study is to clarify the problems of OASI (obstetric anal sphincter injuries) and anal incontinence and prevention of this injury. Review of articles in peer reviewed journals with the usage of Google Scholar function and PubMed. OASI is asevere injury which is more commonly associated with assisted vaginal delivery. This injury cannot be fully prevented, but its incidence can be averted by the usage of selective mediolateral episiotomy, or by other precautionary moves in high risk patients. The treatment of anal incontinence after OASI requires acomplex approach and thorough examination. At first delivery, OASI is not astern indication for caesarean section in accordance with current state of knowledge.

Association of chorioamnionitis with failed conversion of epidural labor analgesia to cesarean delivery anesthesia: A retrospective cohort study.

AimThis study aimed to examine the association between clinically diagnosed chorioamnionitis and failed conversion of epidural labor analgesia to cesarean delivery anesthesia.MethodsThis retrospective, single-center cohort study, conducted in a university hospital, enrolled term parturients undergoing emergency cesarean section after induction of epidural labor analgesia between September 2015 and May 2019. For the purpose of this study, all cases were re-examined to ensure that they fulfilled the criteria of chorioamnionitis, regardless of the actual indication for cesarean section proposed by obstetricians at the time of application. The primary outcome was failure of conversion of epidural labor analgesia to cesarean delivery anesthesia. Multivariable logistic regression analysis was performed to investigate the association between chorioamnionitis and failure of anesthesia for cesarean section.ResultsAmong the 180 parturients reviewed, 58 (43.9%) fulfilled the criteria for chorioamnionitis. Failure of epidural conversion in the chorioamnionitis (+) group was significantly higher than in the chorioamnionitis (-) group (46.6% [27/58] vs. 18.9% [14/74], crude odds ratio = 3.7, 95% confidence interval: 1.7–8.3). After adjustment for potential confounders (age, body mass index, multiparity, and duration for epidural labor analgesia), chorioamnionitis was found to be associated with failure of anesthesia for cesarean sections (adjusted odds ratio = 3.6, 95% confidence interval: 1.6–8.4).ConclusionsChorioamnionitis is associated with the failed conversion of epidural labor analgesia to cesarean delivery anesthesia.

English

BACKGROUND The drastically increasing rate of Caesarean section (CS) is a topic of constant worry and analysis throughout the world. In order to understand the degree to which Caesarean section may be preventable, it is important to know why Caesarean sections are performed. Due to nonexistence of any standard classification for indications of Caesarean section, indications for the same vary among institutions. We wanted to evaluate the rates and predictors of Caesarean section among institutional deliveries in a tertiary care hospital in an economically backward rural area. METHODS This was a cross-sectional prospective study. Pregnant women who underwent Caesarean section (CS) between June 2019 and December 2019 at BLDE (DU) Shri. B. M. Patil Medical College Hospital and Research Centre, Vijayapur, Karnataka, were recruited for the study. Demographic and obstetric data including indications of Caesarean section and pregnancy outcomes were collected and analysed. RESULTS The mean age of the study participants was 24.62 + / - 3.77 years. The study patients were multigravidas, majority delivered at term. The mean gestational age was 38.09 + / - 2.023. The common indications were previous CS (33.1 %), cephalopelvic disproportion (16.9 %), hypertensive disorders of pregnancy (6.7 %) and maternal request (3.4 %). Post-delivery, majority of the babies (78.92 %) were stable and were on mother’s side. CONCLUSIONS Previous caesarean section is the leading cause of Caesarean section in modern era. Hence reduction in primary caesarean section can reduce the rate of over all Caesarean section rate. Clinical, judgmental skills of the obstetrician, legal issues and the patient demands all contribute in the increasing trends of Caesarean section. Hence proper training, obstetric audit, and counselling of the patient party helps in changing the trends of increasing caesarean rate. KEY WORDS Caesarean Section, Indications for Caesarean Section, Maternal Morbidity

Evaluation of Various Indications of Caesarean Section in a Tertiary Care Hospital, Bangladesh

Evaluation of Various Indications of Caesarean Section in a Tertiary Care Hospital, Bangladesh

Robsons Ten Group Classification of Cesarean Section at a Tertiary Center in Nepal.

Increasing trend in Ceasarean birth is the issue of both demand and supply side. One of the recommended tools to characterize every pregnancy admitted for childbirth is Robson ten-group classification system that may evaluate obstetric practice. The aim of the study was to assess the cesarean section pattern based on Robson's classification in a central referral hospital. A retrospective census of childbirths at Paropakar Maternity and Women's Hospital in Kathmandu performed from September 2018 to February 2019 based on obstetric record. Robson ten-group classification system was the research tool to collect data and Robson Classification Report Table was used to evaluate the data. There were 10500 births with 34% (32-35%) overall cesarean section rate. Excluding spontaneous and induced labor the supposedly total prelabor CS is 14.5%. Group 1+2+3 size is 81% and 21% CS; 5+10 had 11.3% and 23.3% respectively. Prelabor CS (2b+4b) is 3.54% and additional 11% from malpresentation and preterm. Group CS rate from Class 5 onwards, and ratio of 1 and 2 are as recommended by Robson; 67% of CS were not picked up by Robson class due to indications evolved as the labor progresses and the attributes not pre-classified. The assessed quality of data and the type of obstetric population by Robson reference values prove this study as a representative research. But the indications of cesarean sections can be predicted for only one-third of pregnancy attributes classified by Robson class. To supplement this tool to reduce rising cesarean birth requires audit of indications at decision making level.

ANALYSIS OF URGENCY, GESTATIONAL AGE AND CONTRIBUTING FACTORS FOR INCREASING CAESAREAN SECTION RATES

Background: Over the past few decades, the indications for Caesarean delivery have broadened thus increasing the rate of caesarean section beyond the set level of WHO. The indications vary in different health care facilities. It is essential to determine the factors responsible for increasing caesarean section rates. To Objectives: nd out the cesarean section rate based on urgency as per RCOG and gestational age as per the categorization of pregnancy by ACOG in a tertiary health care facility catering to large South Indian population. It also aimed to determine the associated conditions contributing for caesarean section. Retrospective analysis of women who underwent caesar Methods: ean section from Jan-2017 to June 2017. Data was analyzed with respect to gestational age, Urgency of caesarean section, maternal fetal indications, clinical characteristics and associated conditions. Neonatal outcomes measured were gestational age, birth weight and NICU admissions. Data was expressed as proportions and percentages. The CS Results: rate was 24.5% among7, 346 deliveries and 81% were emergency CS. Preterm Caesarean sections were done in 18% and term 81.5%. Category II CS were the commonest (49%) followed by Category I (32%). Scarred uterus was the most common indication (85%) for elective caesarean section and fetal distress was most common indication (55.7%) for emergency caesarean sections. The associated factors were prior Caesarean section (32%), Medical disorders in 21% and 2.4% prolonged infertility and ART conceptions. Obstetric conditions including mal presentation were responsible in 19%. On the whole fetal indications accounted for 62%. Conclusion: Fetal indications, especially fetal distress is the most common reason for caesarean section which may have contributed for increased rate of caesarean section. Hence following strict criteria for diagnosis of fetal distress and adopting policies for intrauterine resuscitation prior to decision making for cesarean section would contribute to reduction of CS rate at tertiary health care centers.

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.&#x0D; Objective: To determine the rates, indications, outcomes, and complications of Caesarean section at the Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria.&#x0D; 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.&#x0D; 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.&#x0D; 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.&#x0D; 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%).&#x0D; 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.

The effect of parity on obstetric and perinatal outcomes in pregnancies at the age of 40 and above: a retrospective study

AimTo examine the characteristics of pregnancies at a very advanced age and the effect of parity on adverse obstetric outcomes.MethodsWe retrospectively reviewed the records of women who gave birth at the Obstetrics and Gynecology Department of Okmeydanı Training and Research Hospital between January 2012 and December 2019. Overall, 22 448 of women were younger than 40 and 593 were aged 40 and older. Women aged 40 and older were divided into the primiparous (52 or 8.77%) and multiparous group (541 or 91.23%).ResultsSignificantly more women aged 40 and older had a cesarean section. The most common indications for a secondary cesarean delivery in both age groups were a previous cesarean procedure or uterine operation. The most frequent indication for primary cesarean section in both groups was fetal distress. Cesarean section rates due to non-progressive labor, fetal distress, and preeclampsia were significantly more frequent in primiparous women compared with multiparous women aged 40 and older. In primiparous women, fetal birth weight was lower and preeclampsia/gestational hypertension frequency were higher.ConclusionSince primiparity was a risk factor for lower fetal birth weight and preeclampsia/gestational hypertension in the age group of 40 years and above, more attention should be paid to the follow-up and treatment of these patients.

Cesarean Section in a Maternity Unit of a Tertiary Care Center of Nepal: A Descriptive Cross-sectional Study.

Cesarean section is a common obstetric procedure which is done to reduce complications in high risk pregnancies. The aim of study was to find out the prevalence of cesarean section in a maternity unit of a tertiary care center. A descriptive cross-sectional study was conducted among 497 pregnant women presenting in a maternity unit of a tertiary center of Kathmandu, Nepal over a period of six months from March to August 2017 after taking ethical approval from Institutional Review Committee (Ref. 24). In this study, the prevalence of cesarean section, perinatal outcome, maternal and neonatal complications if any were observed. Data and descriptive analysis were done using Statistical Package for the Social Sciences version 22. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. The prevalence of cesarean section was 171 (34.4%) at 95% Confidence interval (30.2-38.7). Most common indication for cesarean section was fetal distress 53 (31%). The maternal complications developed in 11 (6.4%) among those who delivered via cesarean delivery; Surgical Site Infection being the most common maternal complication. The neonatal intensive care unit admission rate among the newborns via cesarean section delivery was 48 (27.43%) and neonatal sepsis 14 (8%) was most common adverse neonatal outcome. The cesarean rate at the study center is higher than standard target rate of World Health Organization. Neonatal and maternal adverse outcome in current study were comparable with existing literatures.

Optimization of antenatal monitoring approaches of women with chronic inflammatory bowel diseases

Chronic inflammatory bowel diseases (CIBD) affect patients at their peak of reproductive age. Clinical presentation of CIBD in pregnancy is associated with an increased risk of adverse effects in mother and fetus, including prematurity, low birth weight, increased indications for caesarean section. Thus optimizing of the CIBD diagnosis and treatment before and during pregnancy is essential to improve maternal and fetal outcomes.Research aim: to analyze the effectiveness of the CIBD clinical management at the stage of preconception and during pregnancy.Materials and methods. It was searched the Cochrane Library, WHO platform, clinical guidelines, and research reference database Medline. All potential studies have evaluated the clinical practice guidelines in women with CIBD for conception, pregnancy and breastfeeding. Recommendations related to the necessary laboratory and instrumental examination methods, therapeutic strategy, the safety of drugs for mother and fetus, the features of multidisciplinary antenatal observation, the timing and method of delivery of pregnant women with CIBD. Results. Treatment in the planning phase and pregnancy should be multidisciplinary, involving a gastroenterologist, obstetrician-gynecologist, primary care physician, pediatrician and a colorectal surgeon if necessary, as well as stakeholders from the association of patients with CIBD. Communication between these professionals is critical to avoid ambivalent or even conflicting counseling, which is an additional source of anxiety for patients, and also potentially dangerous for suboptimal prevention of clinical CIBD manifestation. Obtained results of the analysis will prevent laboratory and therapeutic polypharmacy and significantly improve the pregnancy outcome.Conclusions. Most women with CIBD had a physiological pregnancy and healthy children. However, some studies have linked CIBD to an increased risk of preterm birth and low birth weight infants. The development of national clinical guidelines will optimize and improve the quality of perinatal care to women with CIBD in the Ukraine, and will lead to a decrease in obstetric, fetal and neonatal complications.

Indications of Preterm Caesarean Section: Experience of 100 Cases at a Tertiary Care Hospital in Bangladesh

Background: Preterm caesarean section is performed for different indication among the pregnant women.&#x0D; Objective: The purpose of the present study was to find out the indications of preterm caesarean section among pregnant women.&#x0D; Methodology: This cross sectional study was conducted in the Department of Obstetric &amp; Gynaecology at Shaheed Ziaur Rahman Medical College Hospital, Bogra, Bangladesh from January 2007 to December 2007 for a period of one year. Women with the gestational age between 32 to 36 completed weeks who were selected for delivery by Caesarean section were selected as study population. All the women of study were assessed on the basis of detailed history, clinical examination, gestational period, history of premature rupture of membranes, any vaginal bleeding and fetal condition.&#x0D; Result: A total number of 100 pregnant women were recruited for this study. In this study most of the pregnant women were in the age group of15 to 20 years which was 40(40.0%) cases followed by the age group of 21 to 25 years which were 20(20.0%) cases. About 43(43.0%) cases were complicated with pregnancy induced hypertension. Almost all of them had indication for immediate caesarean section. Among the group incidence of eclampsia was high which was in 23(23.0%) cases; however, preeclampsia was found in 20(20.0%) cases. Ante partum haemorrhage was reported in 10(10.0%) cases. Pregnant women with premature rupture of membrane (PROM) was found in 14(14.0%) cases; furthermore, PROM with Chorioamnionitis was detected in 5(5.0%) cases. Preterm labour with history of previous caesarean section was given by 5(5.0%) women.&#x0D; Conclusion: In conclusion eclampsia and preeclampsia are the most common indication for preterm caesarean section followed by premature rupture of membrane.&#x0D; Journal of Current and Advance Medical Research, January 2021;8(1):44-48

Study of Primary Caesarean Section in Multiparous Women

Background: Caesarean Section is the operation which is commonly performed worldwide. Caesarean section is a boon to medical field where it has become an safe procedure for the delivery of the baby where delivery is associated with complications. The evolution of caesarean delivery has definitely reduced maternal and fetal mortality in practice of modern obstetrics. A caesarean delivery is typically performed when complications from pregnancy make traditional vaginal birth difficult which makes the life of the mother or child at risk. But there is an alarming increase in conducting caesarean section worldwide as most doctors have started practising defensive medicine. Methods: This prospective observational study was conducted by the Dept of OBG, Melmaruvathur Adhiparaskthi Institute of Medical sciences, Melmaruvathur, Tamil nadufrom November 2018 to April 2019.A total of 92 patients were included in the study on the basis of inclusion criteria. Results: The maximum cases 48(52.2%) were in the age of 21-25 yrs followed by 32(34.8%) in the age group 26-30years. The mean age of the patients was 28.76 (SD16.86) years .Themost common indications for caesarean sections were fetal distress which were seen in 39 cases(42.4%) followed by cephalopelvic disproportion seen in 21 cases (22.8%).Obstructed labour was the least indication noticed which was seen in 4 cases (4.4%).

SARS-CoV-2 in Pregnancy-The First Wave.

Background and Objectives: COVID-19, a disease caused by SARS-CoV-2, is a public health emergency. Data on the effect of the virus on pregnancy are limited. Materials and Methods: We carried out a retrospective descriptive study, in order to evaluate the obstetric results on pregnant women in which SARS-CoV-2 was detected through RT-PCR of the nasopharyngeal swab, at admission to the maternity hospital. Results: From 16 March to 31 July 2020, 12 SARS-CoV-2 positive pregnant women have been hospitalized. Eleven were hospitalized for initiation or induction of labor, corresponding to 0.64% of deliveries in the maternity hospital. One pregnant woman was hospitalized for threatened abortion, culminating in a stillbirth at 20 weeks of gestation. Regarding the severity of the disease, nine women were asymptomatic and three had mild illness (two had associated cough and one headache). Three had relevant environmental exposure and a history of contact with infected persons. None had severe or critical illness due to SARS-CoV-2. There were no maternal deaths. The following gestational complications were observed: one stillbirth, one preterm labor, one preterm prelabor rupture of membranes, and one fetal growth restriction. Four deliveries were eutocic, two vacuum-assisted deliveries and five were cesarean sections. The indications for cesarean section were obstetric. Conclusions: SARS-CoV-2 infection was found in a minority of hospitalized pregnant women in this sample. Most are asymptomatic or have mild illness, from gestational complications to highlight stillbirth and preterm birth. There were no cases of vertical transmission by coronavirus.