Intra-operative Maternal Complications Research Articles

MATERNAL AND FETAL OUTCOME IN EMERGENCY CAESAREAN SECTIONS IN WAD MEDANI OBSTETRICS AND GYNAECOLOGY HOSPITAL GEZIRA STATE-SUDAN

Background: Caesarean section is among the commonest performing procedures worldwide. Its rate is steadily increasing, and its indications is expanding despite the increased morbidity and mortality over the vaginal delivery. Objectives: The aim of this is study is to study the maternal and fetal outcome of emergency caesarean section also the study aims to know the indications for the emergency caesarean sections. Methods: A prospective descriptive study conducted in Wad Medani Teaching Hospital in the period June 20th, 2021, to September 20th, 2021, and included 100 patients who had emergency caesarean sections. All data collected about patients was in included in a flow chart and analysed using SPSS (Statistical Package for Social Sciences) results were tabulated and presented in percentage forms. Results: The study revealed that: the rate of Caesarean section in the hospital was 35% of which 63.4% were emergency CS and 46.6% were elective CS, emergency CS was common in the age group 18-34 years (82%). Emergency CS is common in primigravidae ladies (50%). Most common indications of emergency CS were Failure to progress, repeat CS, Hypertension, fetal distress andmalpresentations. Intraoperative maternal complications such as anaestheticcomplications were (23%), haemorrhage (26%). Postoperative maternal complications such as PPH were (14%), Sepsis (12%), wound infection (6%) and VTE (5%). Regarding the neoanatal outcome in regard of APGAR score less than 7 at 5 were (12%) Other neoanatal complications such as RDS (14%), birth asphyxia (7%).

FETO-MATERNAL OUTCOME OF CAESAREAN SECTION DURING SECOND STAGE OF LABOR IN A TERTIARY CARE HOSPITAL: AN OBSERVATIONAL STUDY

Aim: To highlights the maternal and neonatal outcome of caesarean section in second stage of labour.
 Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynecology at Government Medical College and Hospital Bettiah, Bihar, India from December 2017 to December 2018. total of 24600 women delivered by caesarean section, 16800 emergency and 7800 elective cases. Of these 400 were at full cervical dilatation, >37 weeks gestation with a singleton fetus in cephalic presentation. All caesarean sections performed at full cervical dilatation over the time period of 1 year at a government hospital were included.
 Results: Among the 400 patient’s majority of them were in the age group of 20-30 years (72.5%). about 75.5% of the patients were primigravidae and only the remaining 24.5% were multigravida. The commonest indications for doing caesarean section in the second stage of labour were cephalo pelvic disproportion, fetal distress and obstructed labour. Incidence of PPH is 48 out of 400 cases (12%). Post-operative wound infection was seen in 23(5.75%) and Post-operative fever was seen in 70(17.5%) out of 400 cases. There were no cases of maternal deaths reported. The mean operative time was 52.9 min .The mean length of hospital stays was 6.6 days. Mean weight of the babies of the second stage caesarean section was 3.2 kg.
 Conclusions: Caesarean sections done in second stage of labour are associated with several intra-operative maternal complications and neonatal morbidity.
 Keywords: Caesarean complications; emergency caesarean section; maternal morbidity; neonatal morbidity

Fetal extraction maneuvers during cesarean delivery in the second stage of labor

Objective To compare maternal and neonatal outcomes following cesarean delivery during second stage of labor, according to the fetal extraction method. Methods A retrospective cohort study of all women who underwent term cesarean delivery during the second stage of labor at a university-affiliated tertiary medical center (2012–2016). The cohort was divided according to three extraction methods: standard vertex extraction, the push method in which the head extraction is accompanied by pushing through the vagina, and the reverse breech extraction method. Primary outcomes were intraoperative maternal complications, and secondary outcomes were neonatal adverse events. Results Three hundred and fifty women were included, of whom 206 (59%) underwent standard vertex fetal extraction, 116 (33%) the push method extraction, and 28 (8%) reverse breech extraction. Operation time was significantly shorter in the standard vertex extraction method compared to push and reverse breech extraction methods (33.5 vs. 40.5 and 39.0 min, respectively, p = .013). Uterine laceration and incision extension frequencies were lower in the vertex extraction method as well (24.76 vs. 45.69–46.40% in others, p < .001). Delivery related neonatal injury was significantly more frequent in the reverse breech extraction method (39.29 vs. 12–15% in others, p < .001). In a multivariate analysis reverse breech extraction was associated with higher rates of uterine laceration and incision extension (OR = 2.739 95% confidence interval 1.44–6.56, p = .0237) and delivery related neonatal injury (OR = 2.837, 95% CI: 1.081–7.448, p = .0342). Conclusion Standard vertex extraction method during second stage of labor cesarean delivery is safer both to the mother and neonate when compared to alternative extraction methods. Abbreviations NRFHR: non-reassuring fetal heart rate; NICU: neonatal intensive care unit.

Fetomaternal Outcome in Second Stage Caesarean Section

Introduction: Second stage caesarean section is usually associated with the deeply engaged head, less liquor, and thinned out the lower uterine segment. This can lead to a high risk of maternal morbidities like an extension of the lower uterine segment incision, uterine atony, and injury to urinary bladder as well as neonatal morbidities such as birth asphyxia, NICU admission, and meconium aspiration syndrome. This study aims to observe the maternal and neonatal outcomes of caesarean delivery performed in the second stage of labor.&#x0D; Materials and Methods: This was a retrospective study of the fetomaternal outcome of all women with singleton, a cephalic fetus at term delivered by caesarean section in the second stage of labor over one year at Tribhuwan University Teaching Hospital.&#x0D; Results: During this study period, there were 4653 deliveries. A total of 2274(48.88%) were born by caesarean section, out of which 1739 (76.5%) were elective and 535(23.5%) were emergency. Among emergency LSCS 36(6.72%) were performed in the second stage of labor. Most of the indications were nondescent of head 34(93.5%) followed by intraoperative maternal complications (hematuria; n=14; 38.88%). Postoperative maternal who had complications were prolong catheterization: 14(38.88%), postoperative fever : 10 (27.77%), prolong hospitalization: 5(13.88%). In perinatal complications meconium stain liquor : 10(27.77%), NNU admissions : 5(13.88%), Apgar score &lt;5 at 5 min : 5 (13.55%), NICU admission : 2(5.54%), fresh stillbirth : 1(2.77%) were observed.&#x0D; Conclusions: Caesarean sections done in the second stage of labor are associated with severe maternal and neonatal complications.

Internal podalic version for delivery of high floating head during cesarean section and neonatal outcome.

To evaluate the technique of internal podalic version for delivery of high floating head during cesarean section as an alternative for other methods for its delivery and its effects on neonatal outcome. This study used clinical randomized controlled study design. Three groups of patients each group has 50 patients who attended for elective cesarean section and found to have high floating head during operation, Group I: the babies were delivered by internal podalic version. Group II: the babies were delivered by short curved forceps. Group III: the babies were delivered by vacuum. All groups were compared in regard to time required for delivery of baby, fetal condition, maternal complications, fetal complications and postoperative complications. Hundred-and-fifty patients were selected in the course of preparation of elective cesarean section, all had high floating fetal head, and they were randomly distributed into three groups, each group had 50 patients. There was significant relationship for the favor of Group 1 (study group) as regard the time required for the maneuver as calculated from the end of uterine incision till delivery of whole baby, (24.86, 59.48,54.52 s for Group I, Group II, Group III, respectively) with P-value <0.00001*. Also there was significant relationship as regard the intraoperative maternal complications for the favor of Group I with P-value =0.004. While there was an insignificant relationship between the three groups as regard preoperative data, APGAR score, fetal birth weight, postoperative pain and postoperative maternal data. Despite that there was a significant difference as regard the postoperative neonatal complications, with P-value =0.002*, all these complications were minor and did not need long-term treatment. Use of internal podalic version for delivery of high floating head during cesarean section is a safe and rapid technique, with less maternal and neonatal complications.

Caesarean Section During Second Stage of Labor in a Tertiary Centre.

There is an alarming rise in caesarean section leading to increased adverse outcomes for both the mother and fetus when compared with vaginal delivery. Within this increasing caesarean section rate, there is a concerning increase in the rate of second stage caesarean section. This study highlight the feto-maternal outcome of caesarean section in second stage of labour. This was a retrospective cohort review of all women with a singleton, cephalic fetus at term delivered by caesarean section in the second stage of labor between April 1, 2013 and March 30, 2017 at Patan Academy of Health Sciences. The main outcome measures were second stage caesarean section, indications and its maternal and fetal morbidity. During the study period, there were 40,860 deliveries. A total of 18,011 (44%) babies were born by caesarean section, 10484 emergency and 7527 elective. Out of the emergency caesarean section, 200 (1.9 %) were performed in second stage of labor. In this study, the most common indication was cephalopelvic disproportion. (92.4%) were delivered without a trial of instrumental delivery. In terms of maternal complications, atonic post partum haemorrhage uterine incision extension 18 (12.5%), postoperative fever 27(18.8%), wound infection 7 (4.8%) were observed. In perinatal complications, meconium stained amniotic fluid 49(34.2%), neonatal hyperbilirubinemia 14(9.7%) and increased nursery admission 2(15.3%) and 2(1.3%) perinatal mortality were seen. Cesarean sections done in second stage of labor are associated with several intra-operative maternal complications and neonatal morbidity.

Maternal complications in repeated Caesarean section

Maternal complications in repeat cesarean section are increasing with the rising rate of cesarean section in the world. The aim of this study to evaluate intra-operative maternal complications of previous one and two cesarean section. It needs to the highlight for proper antenatal care and complication can be anticipated during surgery.Objective:To determine the frequency of intra-operative maternal complications among women undergoing repeated Caesarean section at Isra University hospital, Hyderabad.Material and methods:STUDY DESIGN: Cross-sectionalSETTING: The study was conducted obstetric and gynecology department of Isra University Hospital Hyderabad.DURATION OF STUDY: The study was of six months and the study process was carried out from 15th Agust 2011 to 15th February 2012.SAMPLE SIZE: 280 casesSAMPLE TECHNIQUE: Non probability, purposive samplingSAMPLE SELECTION:Inclusion criteria: All the pregnant women with history of previous one and previous to caesarean section availing obstetric and gynecology facilities at Isra University Hospital, Hyderabad Women regardless of any age group.  Exclusion criteria:•         Pregnant women with no history of caesarean section•         Pregnant women who refused to participate in the studyRESULTS:     The mean + SD age was found to be 29.94 + 5.03 years; The maximum age of participants in this study was 45 years while the minimum age was 17 years. The age distribution of study participants was normally distributed. Regarding intra-operative complications, the prevalence of Adhesion is very high and alarming i.e. 97.5% among pregnant women undergoing repeated Caesarean section delivery. The prevalence of uterine scar dehiscence was not very high and it was confined to 17.9% in our study. The prevalence of difficult delivery of fetus a maternal complication was around 12% in our sample. The prevalence of excessive blood loss as an Intra-operative maternal complication was found to be 19% in our study. The prevalence of Caesarean Hysterectomy as an Intra-operative maternal complication was very minimum i.e. <2% in our sample. With regard to the association of age with intra-operative complication Adhesion among study participants, there was no difference in the mean age of two groups as evidenced by p-value of 0.103. Moreover, there was no association between age with intra-operative complication uterine scar dehiscence as evidenced by p-value of 0.837. Interestingly no association was observed between previous history of Caesarean section with intra-operative complication Adhesion among study participants. There was a significant association between previous history of Caesarean section and uterine scar dehiscence in our study.Conclusion: The present research makes a strong case that the prevalence of intra-operative complications among pregnant women undergoing repeated Caesarean section is not uncommon at Isra University hospital Hyderabad, Pakistan. This issue can have serious implications for maternal mortality and morbidity. Multiple cesarean deliveries are associated with one of the intra-operative complications “Uterine scar dehiscence”. The risk of major complications increases with cesarean delivery number.

Maternal complications in repeated Caesarean section

Maternal complications in repeat cesarean section are increasing with the rising rate of cesarean section in the world. The aim of this study to evaluate intra-operative maternal complications of previous one and two cesarean section. It needs to the highlight for proper antenatal care and complication can be anticipated during surgery.Objective:To determine the frequency of intra-operative maternal complications among women undergoing repeated Caesarean section at Isra University hospital, Hyderabad.Material and methods:STUDY DESIGN: Cross-sectionalSETTING: The study was conducted obstetric and gynecology department of Isra University Hospital Hyderabad.DURATION OF STUDY: The study was of six months and the study process was carried out from 15th Agust 2011 to 15th February 2012.SAMPLE SIZE: 280 casesSAMPLE TECHNIQUE: Non probability, purposive samplingSAMPLE SELECTION:Inclusion criteria: All the pregnant women with history of previous one and previous to caesarean section availing obstetric and gynecology facilities at Isra University Hospital, Hyderabad Women regardless of any age group.  Exclusion criteria:•         Pregnant women with no history of caesarean section•         Pregnant women who refused to participate in the studyRESULTS:     The mean + SD age was found to be 29.94 + 5.03 years; The maximum age of participants in this study was 45 years while the minimum age was 17 years. The age distribution of study participants was normally distributed. Regarding intra-operative complications, the prevalence of Adhesion is very high and alarming i.e. 97.5% among pregnant women undergoing repeated Caesarean section delivery. The prevalence of uterine scar dehiscence was not very high and it was confined to 17.9% in our study. The prevalence of difficult delivery of fetus a maternal complication was around 12% in our sample. The prevalence of excessive blood loss as an Intra-operative maternal complication was found to be 19% in our study. The prevalence of Caesarean Hysterectomy as an Intra-operative maternal complication was very minimum i.e. <2% in our sample. With regard to the association of age with intra-operative complication Adhesion among study participants, there was no difference in the mean age of two groups as evidenced by p-value of 0.103. Moreover, there was no association between age with intra-operative complication uterine scar dehiscence as evidenced by p-value of 0.837. Interestingly no association was observed between previous history of Caesarean section with intra-operative complication Adhesion among study participants. There was a significant association between previous history of Caesarean section and uterine scar dehiscence in our study.Conclusion: The present research makes a strong case that the prevalence of intra-operative complications among pregnant women undergoing repeated Caesarean section is not uncommon at Isra University hospital Hyderabad, Pakistan. This issue can have serious implications for maternal mortality and morbidity. Multiple cesarean deliveries are associated with one of the intra-operative complications “Uterine scar dehiscence”. The risk of major complications increases with cesarean delivery number.

Fetomaternal Outcome in Cesarean Sections Done in Second Stage of Labor

Objective: To study the fetomaternal outcome in cesarean sections done in second stage of labor. Method: It is a prospective observational study of 26 cases of cesarean sections done in second stage of labor in Adichunchanagiri institute of medical sciences from January to September 2014. Result: There were 1533 deliveries including 468 cesarean sections in the study period. The cesarean rate was 30%. Of 468 cases 26 were performed in second stage of labor contributing 1.6% of total deliveries and 5.5% of all cesarean sections. Most common indication for cesarean section in second stage of labor is deep transverse arrest. Second stage cesarean sections are associated with increased risk of atonic PPH requiring surgical management (7.69%), lower segment tears including angle extension and broad ligament hematoma(15.38%) along with other complications like extraction difficulty, post operative fever, wound sepsis, longer duration of hospital stay. Meconium stained amniotic fluid is present in 30.76% cases. Though timely second stage ceserean sections reduce perinatal mortality few complications like neonatal hyperbilirubinemia occur. Conclusion: Cesarean sections done in second stage of labor are associated with increased intra-operative maternal complications and neonatal morbidity. Theme: Healthy mother, healthy baby: Timely intervention to reduce fetomaternal complications. Key words: Cesarean section, Second stage of labor, Maternal morbidity, Complications

Intra-operative Maternal Complications of Emergency Cesarean Section Done in Advanced Labor

Abstract Background: Emergency cesarean section done in advanced labor is a big challenge in obstetrics due to increased risk of intraoperative complications. In the last decade, a rapid increase in cesarean section done in advanced labor has been observed. Difficult deli-very of the fetal head during cesarean section carries a high risk of intraoperative complications like cervical and uterine tears, intra operative hemorrhage and trau-ma to the baby. Objectives: The purpose of this study is to find out the frequency and risk factors for intra-operative com-plications in emergency cesarean section done in adva-nced labor, so that appropriate management protocols can be planned to reduce these complications. Study Design: Prospective cohort study. Materials and Methods: This prospective study was carried out in Obstetrics and Gynecology Unit - 2 of Services Institute of Medical Sciences, Services Hos-pital, Lahore; from 1 st January 2007 to 31 st December 2007. All patients undergoing emergency cesarean sections done on laboring mothers were included in the study. The sample was divided into two groups; emergency C-section done in advanced labor as the study group and emergency C-section in early labor as the control group. Data were collected regarding age, parity, booked or unbooked status, indications for ces-arean section, level of competence of operating sur-geon, intra-operative complications and the risk factors for these complications. Data were recorded on a stru-ctured proforma and compared between the two gro-ups. Statistical Analysis: Data were analyzed using com-puter programme SPSS Version 14 for windows appl-ying student t-test for quantitative and chai square test for qualitative parameters. A p-value < 0.05 was used as statistically significant. Results: Out of 2064 total deliveries in the year 2007, 1290 (62.5%) were vaginal deliveries and 774 (37.5%) were C-Sections. Out of 774 C-Section, 174 (23%) were elective and 600 (77%) were emergency. Out of 600 emergency C-sections, 402 (59%) were done on laboring mothers and 198 (41%) were done on non-laboring mothers for indications like placenta previa, eclampsia, etc. Out of 402 C-sections done on laboring mothers, 241 (60%) were done in advanced labor and 161 (40%) in early labpr. The intra-operative compli-cation rate was 19.8% versus 11% (p-value 0.001) in the study and control group respectively. The main indications for cesarean section in labor were prolonged labor, deep transverse arrest of fetal head and fetal distress. The main complications noticed were the cer-vico - uterine lacerations and intra-operative hemorr-hage. Factors associated with increased maternal com-plications were; un-booked cases (p-value 0.01), stat-ion of the fetal head (p-value 0.02), good size baby (p-value 0.01) and experience of surgeon (p-value 0.04). Conclusion: Emergency cesarean section done in advanced labor is a high risk operation with significant maternal morbidity in terms of cervico - uterine tears and intra-operative bleeding. Key Words: Emergency cesarean section, advanced labor, maternal complications, cervicouterinetears, intraoperativehemorrhage.

Effectiveness of Double Cervical Cerclage in Women With at Least One Previous Pregnancy Loss in the Second Trimester: A Randomized Controlled Trial

Cervical cerclage is widely used to prevent preterm birth in women at moderate or high risk of prematurity due to a history of preterm birth in the second trimester. Several studies reported, however, that cerclage is not effective; one study found no difference in the risk of preterm birth between cerclage and bed rest alone. Many of these studies, however, can be criticized because of deficiencies in design. A number of authors believe that placement of the suture close to the internal os may improve perinatal outcomes. Most studies investigating cerclage have used a single purse-string cerclage suture. The investigators in the present study suggest that use of a single suture is inadequate, no matter where it is placed in the cervix. This prospective randomized controlled pilot study compared the effect of double cervical cerclage with traditional single cervical cerclage on the frequency of preterm birth, perinatal outcomes, and maternal side effects in 51 singleton women with a history of pregnancy loss in the second trimester and suspected cervical incompetence. The participants were randomized into 2 groups: double cervical cerclage (n = 17) and traditional single cervical cerclage (n = 34). The effect of using double or single cervical sutures on a number of outcomes was compared. Outcomes examined included the duration of pregnancy, perinatal outcomes, maternal hospital stay, neonatal death, and neonatal admission to the intensive care unit. At less than 34 weeks of gestation, there was a nonsignificant difference in the rate of preterm delivery between the 2 groups favoring double cerclage, 12% versus 41%. At less than 28 weeks of gestation, the incidence of preterm delivery was lower (but not significantly) in the double cervical cerclage group compared to the single cerclage group, 6% versus 29%. The mean birth weight in the double cerclage group was higher (double suture: 2696 ± 911 vs. single suture: 2242 ± 1119 g, P = 0.048). The rates of neonatal survival and admission to the intensive care unit were not significantly different in the 2 groups. Few neonatal complications and no intraoperative maternal complications were associated with use of double cervical cerclage. The findings of this pilot study suggest that double cervical cerclage is effective and may be more effective than traditional single cervical cerclage in preventing preterm delivery and improving perinatal outcome among women with a prior history of premature delivery in the second trimester.