Prevalence Of Cesarean Section Research Articles

Cesarean in Adolescents at the Rural Hospital of Neisu (Democratic Republic of Congo): Epidemiological Aspects and Neonatal and Maternal Prognosis

Aim: We attempted to determine the epidemiological aspect of cesarean section performed in adolescent girls at Neisu Rural Hospital, DR Congo, and maternal and neonatal prognosis, whereby to contribute to the reduction of maternal and neonatal morbidity and mortality.
 Methods: Descriptive cross-sectional study from January 1st, 2016 to June 30th 2018, involving 114 cases of caesarean section of 13 to 19 year-olds. Maternal and perinatal data were analyzed on the SPSS 20.0 software.
 Results: The prevalence of caesarean section among adolescents was 24.8%. The majority of female deliveries had a low level of education (80.7%), half were married, 30.7% were transfer cases, 77.2% were primiparous, and 100% christian and 81.6% had not followed quality prenatal consultations. Cesarean section was done in emergency (97.4%) under spinal anesthesia (69.3%) and especially indicated for feto-pelvic disproportion (69.3%). In newborns there was: 1.8% of prematurity; 21.1% of low weight; 14.9% of resuscitation; 3.5% of Apgar <7 in the 5th minute; 9.6% of neonatal infection and 43.9‰ perinatal mortality. Concerning the maternal prognosis: 10.5% of severe anemia; 16.7% of parietal infection; 16.7% endometritis and 8.8‰ of maternal mortality.
 Conclusion: The cesarean section in adolescent girls to Neisu is a public health problem and the fetal-maternal prognosis is worrying.

Prevalence of Cesarean Section and Its Indications in A Tertiary Care Hospital

Cesarean section is a surgical procedure performed to deliver fetus through abdominal route. Increasing rate of cesarean section worldwide is an alarming concern for public health and obstetricians due to increase in financial burden and risk to health of the mother in comparison to vaginal delivery. The aim of the study was to find the prevalence of cesarean section and its most common indication in a tertiary care hospital. This descriptive cross-sectional study was done in a tertiary care hospital, from July 2016 to June 2018 after taking ethical clearance from institutional review board registration number 38970/062/063. Convenience sampling was done. Data was collected and entry was done in microsoft excel, point estimate at 95% CI was calculated along with frequency and proportion for binary data. Out of total deliveries conducted, 862 (36.8%) were CS deliveries, 1477 (63.1%) were vaginal deliveries, and 12 (0.51%) were instrumental deliveries. Prevalence of CS is 862 (36.8%) at 95% CI (34.82%-38.78%). Mean age±S.D of delivering mother was found to be 26.1±0.25 years. Primi cesarean section was more than repeat cesarean section. Most common indication of cesarean section was fetal distress 243 (28%) followed by previous cesarean section 165 (18%), non-progress of labour 106 (12%), oligohydramnios 59 (7%), malpresentation 59 (7%), cephalo pelvic disorders 52 (6.5%), and hypertensive disorder in pregnancy 33 (4%). Prevalence of cesarean section in a tertiary care hospital is high compared to WHO data. The most common indication of cesarean section are fetal distress and previous cesarean section.

Early vs. standard screening and treatment of gestational diabetes in high-risk women – An attempt to determine relative advantages and disadvantages

Background and aimsScreening for Gestational Diabetes (GDM) is usually recommended between 24 and 28 weeks of pregnancy; however available evidence suggests that GDM may be already present before recommended time for screening, in particular among high-risk women as those with prior GDM or obesity. The purpose of this retrospective study was to evaluate whether early screening (16–18 weeks) and treatment of GDM may improve maternal and fetal outcomes. Methods and resultsIn 290 women at high-risk for GDM, we analyzed maternal and fetal outcomes, according to early or standard screening and GDM diagnosis time. Early screening was performed by 50% of high-risk women. The prevalence of GDM was 62%. Among those who underwent early screened, GDM was diagnosed at the first evaluation in 42.7%. Women with early diagnosis were more frequently treated with insulin and had a slightly lower HbA1c than women with who were diagnosed late. No differences were observed in the prevalence of Cesarean section, operative delivery, gestational age at the delivery, macrosomia, neonatal weight, Ponderal Index and Large-for-Gestational-Age among women with early or late GDM diagnosis or NGT. However, compared to NGT women, GDM women, irrespective of the time of diagnosis, had a lower gestational weight gain, lower prevalence of macrosomia (3.9% vs. 11.4%), small (1.7% vs. 8.3%) as well as large for gestational age (3.3% vs. 16.7%), but higher prevalence of pre-term delivery (8.9% vs. 2.7%). ConclusionEarly vs. standard screening and treatment of GDM in high-risk women is associated with similar short-term maternal-fetal outcomes, although women with an early diagnosis were treated to a greater extent with insulin therapy.

The Prevalence of Cesarean Section in Misan Province and It's Indicating Factors

The Prevalence of Cesarean Section in Misan Province and It's Indicating Factors

Prevalence of Cesarean Section and Analysis of Neonatal Apgar Score and the Mean Time of Second Phase of Labor in Pregnant Women.

Introduction:The labor pain is probably the most severe pain a mother experiences in her lifetime and is usually severe and prolonged in women with pregnancy,Aim:To evaluate the effects of labor epidural and spinal analgesia on the incidence of cesarean section in painless delivery.Methods:This randomized clinical trial was conducted on pregnant women aged 37-42 weeks of pregnancy. Female candidates for painless labor were divided into two groups: Epidural Analgesia (EA) and Spinal Analgesia (SA). Patients in the labor epidural group underwent analgesia using marcaine and fentanyl and after fully assuring the normal hemodynamic status of the mother and fetal hearth rate (FHR), labor spinal analgesia was used for other group.Results:The average age of mothers was 27.5 years, their mean gestational age was 39 weeks and their mean weight was determined to be 72 kg. Frequency of cesarean delivery in mothers was found as 12.9%. Significantly, the incidence of cesarean section in the labor epidural analgesia group was higher than the labor spinal analgesia group (P = 0.02). In addition, the mean second phase of delivery in the labor epidural analgesia group was significantly higher than the labor spinal analgesia group (P = 0.03). There was no significant in 1st and 5th min Apgar scores between groups in infants (8.6 and 9.6, respectively).Conclusion:Labor epidural analgesia and labor spinal analgesia result in a significant reduction in pain due to normal delivery. Due to the similarity of Apgar and arterial blood gas (ABG) in neonates, labor epidural analgesia may serve as an alternative in childbirth delivery.

Cesarean Sections under General Anesthesia at a Tertiary Care Center in Western Nepal: A Descriptive Cross-sectional Study

General anesthesia is feared to have adverse feto-maternal outcomes compared to neuraxial anesthesia. It is recommended to keep rate of caesarean sections under general anesthesia below 5% and 15% for elective and emergency caesarean sections respectively. This study was conducted to find out the prevalence of caesarean sections under general anesthesia at a tertiary care center in western Nepal. A descriptive cross-sectional study was conducted among caesarean sections conducted at Manipal Teaching Hospital, Pokhara, Nepal from January 2014 to December 2017. Ethical approval was taken from the Institutional Review Committee with reference number MEMG/IRC/GA/122. All the caesarean sections conducted during this study period were included in the study using whole sampling method. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Data for each patient was subsequently entered into an Excel spreadsheet and analyzed using Statistical Package for Social Sciences version 20. Among 3613 cases, caesarean sections under general anesthesia was observed in 175 (4.84%) in our center over a period of four years at 95% Confidence Interval (4.13-5.55%). The yearly variations ranges from 2.83% to 8.99%. The rate of general anesthesia was found slightly higher in elective 31 (5.82%) as compared to emergency caesarean section 144 (4.67%). The four year medical records of our institution showed fluctuating trend of caesarian sections under general anesthesia. The rate of general anesthesia for emergency caesarian section was within the recommended rate while it was slightly higher in elective caesarian section.

Faktori koji utiču na izbor anestezije kod trudnica za porođaj carskim rezom

Objectives: In recent years, a significant increase has been observed in the prevalence of caesarean sections (CS). Although as in many other countries, CS rates in Turkey are higher than the targeted rate. This increase in the prevalence of CS also affects obstetric anaesthesia. In this study, we investigate the choice of anaesthesia among pregnant women who are scheduled for CS, as well as general anaesthesia and regional anaesthesia rates, the reasons for choosing general anaesthesia or regional anaesthesia, and the factors that affect their choices. Methods: A questionnaire consisting of 20 questions were applied to pregnant women applying for delivery by elective caesarean operation, between November 2011 to November 2012, in order to study the anaesthesia technique they prefer and the reason behind their preferences. The questionnaire was applied to pregnant women during the visit, on the day before the operation or while they were waiting in the waiting room before the CS procedure. Results: Our study revealed that age, gravida, previous type of delivery, previous anaesthesia experience, employment status, monthly income level, educational status, being given information about anaesthesia in advance, the source of information, and being diagnosed with panic disorder were all found to be influential in the decision of which type of anaesthesia to opt for. Conclusion: We have found out that the reason why pregnant women who have higher educational status, who work and have high level of monthly-income prefer regional anaesthesia method more depends on the fact that they have more information on anaesthesia method, they have more common use of the internet and the information they obtain from the people around them is not prejudiced against regional anaesthesia method. We believe that as the education levels rise in the future and the patient population becomes more aware, which will direct them to do more research, their preference rates will change.

Prevalence of cesarean section and its associated factors in a tertiary care centre

Prevalence of cesarean section and its associated factors in a tertiary care centre

CAESAREAN SECTION

Background: All over the world the rate of caesarean section is increasing dayby day due to multiple factors and Pakistan is no exception to it. According to World HealthOrganization (WHO) the rate of caesarean section varies from 5% to 15%. This rate of C-sectionis acceptable to WHO and is considered as justifiable which differs from country to country dueto diverse socio economic conditions, literacy rate, medico legal issues as well as availabilitiesof health care facilities to patients and especially antenatal facilities. Objectives: To analyzethe rate and indications of caesarean section in primigravida. Study Design: Descriptive study.Setting: Government Sardar Begum Hospital Sialkot. Period: 1st January 2017 to 31st December2017. Materials and Methods: Inclusion and exclusion criteria were made and all patients whichunderwent caesarean section were included in the study and all patients delivered vaginally wereexcluded from the study. A proforma was designed specially to record the different parameters/information of patients and indications of c-section. Data was analyzed using SPSS version 22.Results: Total caesarean section rate was 40 %, out of which 30.87% were Primigravida and69.13% were multigravida. Failure to progress was the most common indication and only in0.47% patients, obstructed labour was an indication of C-section. Conclusion: In primigravidawomen the prevalence of Caesarean Section is increased which also lead to enhance repeatcaesarean section chances and it is not free of risk. It is risk factor for placenta pervia, further,repeat caesarean section adherent morbidly placenta which increased the chances of hugePPH and acute maternal morbidity and mortality.

INDICATIONS AND RATE OF CAESAREAN SECTION IN PRIMIGRAVIDA

Background: All over the world the rate of caesarean section is increasing dayby day due to multiple factors and Pakistan is no exception to it. According to World HealthOrganization (WHO) the rate of caesarean section varies from 5% to 15%. This rate of C-sectionis acceptable to WHO and is considered as justifiable which differs from country to country dueto diverse socio economic conditions, literacy rate, medico legal issues as well as availabilitiesof health care facilities to patients and especially antenatal facilities. Objectives: To analyzethe rate and indications of caesarean section in primigravida. Study Design: Descriptive study.Setting: Government Sardar Begum Hospital Sialkot. Period: 1st January 2017 to 31st December2017. Materials and Methods: Inclusion and exclusion criteria were made and all patients whichunderwent caesarean section were included in the study and all patients delivered vaginally wereexcluded from the study. A proforma was designed specially to record the different parameters/information of patients and indications of c-section. Data was analyzed using SPSS version 22.Results: Total caesarean section rate was 40 %, out of which 30.87% were Primigravida and69.13% were multigravida. Failure to progress was the most common indication and only in0.47% patients, obstructed labour was an indication of C-section. Conclusion: In primigravidawomen the prevalence of Caesarean Section is increased which also lead to enhance repeatcaesarean section chances and it is not free of risk. It is risk factor for placenta pervia, further,repeat caesarean section adherent morbidly placenta which increased the chances of hugePPH and acute maternal morbidity and mortality.

An approach to identify a minimum and rational proportion of caesarean sections in resource-poor settings: a global network study.

SummaryBackgroundCaesarean section prevalence is increasing in Asia and Latin America while remaining low in most African regions. Caesarean section delivery is effective for saving maternal and infant lives when they are provided for medically-indicated reasons. On the basis of ecological studies, caesarean delivery prevalence between 9% and 19% has been associated with better maternal and perinatal outcomes, such as reduced maternal land fetal mortality. However, the specific prevalence of obstetric and medical complications that require caesarean section have not been established, especially in low-income and middle-income countries (LMICs). We sought to provide information to inform the approach to the provision of caesarean section in low-resource settings.MethodsWe did a literature review to establish the prevalence of obstetric and medical conditions for six potentially life-saving indications for which caesarean section could reduce mortality in LMICs. We then analysed a large, prospective population-based dataset from six LMICs (Argentina, Guatemala, Kenya, India, Pakistan, and Zambia) to determine the prevalence of caesarean section by indication for each site. We considered that an acceptable number of events would be between the 25th and 75th percentile of those found in the literature.FindingsBetween Jan 1, 2010, and Dec 31, 2013, we enrolled a total of 271 855 deliveries in six LMICs (seven research sites). Caesarean section prevalence ranged from 35% (3467 of 9813 deliveries in Argentina) to 1% (303 of 16 764 deliveries in Zambia). Argentina’s and Guatemala’s sites all met the minimum 25th percentile for five of six indications, whereas sites in Zambia and Kenya did not reach the minimum prevalence for caesarean section for any of the indications. Across all sites, a minimum overall caesarean section of 9% was needed to meet the prevalence of the six indications in the population studied.InterpretationIn the site with high caesarean section prevalence, more than half of the procedures were not done for life-saving conditions, whereas the sites with low proportions of caesarean section (below 9%) had an insufficient number of caesarean procedures to cover those life-threatening causes. Attempts to establish a minimum caesarean prevalence should go together with focusing on the life-threatening causes for the mother and child. Simple methods should be developed to allow timely detection of life-threatening conditions, to explore actions that can remedy those conditions, and the timely transfer of women with those conditions to health centres that could provide adequate care for those conditions.

Disparities in caesarean section prevalence and determinants across sub-Saharan Africa countries

BackgroundAccess to safe Cesarean section (C-section) in resource-constrained settings such as sub-Sahara Africa (SSA) region is a foremost approach to reduce maternal mortality. C-section is an obstetric operative procedure used appropriately to improve delivery outcomes. However, errors in the procedure have enormous potential harm that may outweigh the benefits. This study assessed the prevalence and determinants of C-section in several SSA countries. This study examined the prevalence and determinants associated with cesarean delivery in SSA countries.MethodsSecondary data of women of reproductive age (15-49 years) from the current Demographic and Health Survey (DHS) in 34 SSA countries was utilized in this study. The mode of delivery among women was the primary outcome variable. Percentage and descriptive statistics were used to conduct univariate analyses. Furthermore, multivariable multilevel logistic regression was used to investigate correlates of C-section among SSA women.ResultsResults showed disparities in the percentage of C-section among women from 34 SSA countries. C-section at public healthcare settings ranged from 3% in Burkina Faso to 15.6% in Ghana. However, in private healthcare settings, C-section ranged from 0% in Sao Tome and Principe to 64.2% in Rwanda. Overall, C-section was 7.9% from public healthcare and 12.3% from private healthcare facilities respectively. In the adjusted regression model; women aged 35–49 had increase in the odds of C-section, while a unit increase in the number of children ever born had 17 and 20% significant reduction in the odds of C-section in public and private healthcare respectively. Assessing public healthcare settings; women from richer/richest households, male and large size children at birth had increase in the odds of C-section, while those from rich neighbourhood had reduction in the odds of C-section. In private healthcare settings, women with high decision making power and multiple births had increase in the odds of C-section, while those who attended ANC visits had significant reduction in the odds of C-section.ConclusionThe findings from this study would help formulate health policies and implement actions that would improve the outcome of C-section care. Monitoring of emergency obstetric care services is necessary to address issues connected to poor C-section outcomes in resource-constrained settings. Also training of medical personnel including midwives and nurses in emergency obstetric care, ensuring accessibility to life-saving drugs and supplies should be encouraged in health care system.

538 Effects of female genital mutilation/cutting on birth - a retrospective case-control-study

An estimated amount of 100-140 million girls and women worldwide are currently living with female genital cutting. Due to migration trends, European doctors are more and more often confronted with this practice and the consequences it might bring. The aim of this study was to determine whether women with FGC had a higher prevalence of caesarean section than women without FGC. Moreover, maternal and fetal outcomes for women with FGC compared to women without FGC were examined. A retrospective case-control study was conducted. All women with FGC were identified from the records of the Department of Obstetrics and Gynaecology in the General Hospital in Vienna. Data from 65 births were available and for every delivery a woman without FGC was matched as a control patient. The women were matched for maternal age. In the group of women with FGC 26 (40%) caesarean sections were performed and 25 (38,5%) were carried out in the control group. Therefore, a substantial statistical difference between the two groups could not be seen. There was also no statistically significant difference between lacerations, birth weight, blood loss, instrumental vaginal delivery, size of the child, umbilical cord pH, Apgar Score after 1,5 and 10 minutes or stillbirth in women with FGC compared to controls. Patients with FGC had significantly more often an episiotomy than women without FGC (p = .035).

Monitoring and interventions are needed to reduce the very high Caesarean section rates in Vietnam.

The aim of this study was to estimate the prevalence of Caesarean sections in the third largest city in Vietnam and identify the associated risk factors. This descriptive study was conducted in Da Nang from April 2015 to March 2016 and the hospital-based sample comprised 20 535 women who delivered during this period. Caesarean section cases were categorised into private and public hospitals and groups of primiparous and multiparous women. We recruited 10 of the 12 hospitals in the City and they covered 90% of births during the study period. The overall Caesarean section rate was 58.6%: 57.9% in public hospitals and 70.6% in private hospitals. The three main indications for Caesarean sections were previous Caesarean sections, cephalopelvic disproportion and foetal distress. The factors that increased the likelihood of Caesarean sections were the mother being over 30, having an office job, a history of abortions, having a male infant and a higher neonatal birth weight. Our study demonstrated an extremely high rate of Caesarean section and associated factors in public and private hospitals in one of the biggest cities in Vietnam. The findings highlight the need for monitoring and interventions to reduce the Caesarean section rates.

Brazilian regional differences and factors associated with the prevalence of cesarean sections

Abstract Introduction: Brazil presents high C-section prevalence rates. Several factors may be associated with such high rates. Objective: To observe and analyze factors associated with the prevalence of cesarean sections in Brazil, according to their occurrence in Brazilian regions. Methods: An ecological study, having C-section as the outcome, from 1990 to 2013, in Brazilian regions, using data from the Brazilian National Health Survey, 2013. Records of women in their reproductive period, aged between 18 and 49 years, were included, totaling a sample of 16,175 women. Descriptive and bivariate analysis was carried out with logistic regression. Results: The prevalence of cesarean sections in Brazil was 53.03%. Vaginal delivery was more prevalent in the North (52.74%) and Northeast (51.06%) regions, while C-section was more prevalent in the Southeast (59.32%), South (56.96%) and Midwest (61.48%) regions. Over the years, an increased probability of cesarean sections was observed, particularly in the following regions: Northeast (2.21 times more, CI95%: 1,42 - 3,46) and South (2.75 times more, CI95%: 1,44 - 5,23). Women with higher levels of education are 2.05 times (CI95%: 1.27 - 3.30) more likely to have a C-section, especially those in the Northern and Southern regions. In the Northeast, this probability increased, regardless of the level of education. Conclusion: The prevalence of cesarean sections in Brazil is high and, over the years, factors such as level of education, maternal age and having health insurance, seem to contribute to the increase in surgical deliveries.

Factors Associated with Cesarean Section in Tehran, Iran using Multilevel Logistic Regression Model.

ObjectivesOver the past few decades, the prevalence of cesarean sections (CS) have risen dramatically worldwide, particularly in Iran. The aim of this study was to determine the prevalence of CS in Tehran, and to examine the associated risk factors.MethodsA cross-sectional study of 4,308 pregnant women with singleton live-births in Tehran, Iran, between July 6–21, 2015 was performed. Multilevel logistic regression analysis was performed using demographic and obstetrical variables at the first level, and hospitals as a variable at the second level.ResultsThe incidence of CS was 72.0%. Multivariate analysis showed a significant relationship between CS and the mother’s age, socioeconomic status, body mass index, parity, type of pregnancy, preeclampsia, infant height, and baby’s head circumference. The intra-class correlation using the second level variable, the hospital was 0.292, indicating approximately 29.2% of the total variation in the response variable accounted for by the hospital.ConclusionThe incidence of CS was substantially higher than other countries. Therefore, educational and psychological interventions are necessary to reduce CS rates amongst pregnant Iranian women.

Factors associated with cesarean sections in a high complexity university hospital in southern Brazil.

Objective To identify the factors associated with cesarean sections in a high complexity university hospital in southern Brazil. Methods Cross-sectional study carried out at the Obstetric Hospital Unit of the Hospital de Clínicas de Porto Alegre. Data were gathered from questionnaires carried out with 361 puerperal women and maternal and neonatal records, from February to April 2013. For the analysis, Prevalence Ratio through Univariate Poisson Regression was used. Results The prevalence of cesarean sections was 31%. The category of hospitalization, cervix dilation and its characteristics, fetal presentation, and uterine dynamics, at the time of admission, were statistically related to cesarean sections; not having a previous cesarean section and night shift (from midnight to 6AM) were protective factors. Conclusions The prevalence of cesarean sections is above the rate recommended by the World Health Organization, but it is similar to rates found in other university hospitals, thus pointing out the need for the proposition of actions aimed at improving this indicator.

MP75-20 LONG-TERM OUTCOMES OF LAPAROSCOPIC REPAIR OF VESICOUTERINE FISTULA: EXPERIENCE FROM A TERTIARY CARE CENTRE OF NORTHERN INDIA

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy III1 Apr 2018MP75-20 LONG-TERM OUTCOMES OF LAPAROSCOPIC REPAIR OF VESICOUTERINE FISTULA: EXPERIENCE FROM A TERTIARY CARE CENTRE OF NORTHERN INDIA Vishwajeet Singh, Sunny goel, Seema Mehrotra, and Rahul Janak Sinha Vishwajeet SinghVishwajeet Singh More articles by this author , Sunny goelSunny goel More articles by this author , Seema MehrotraSeema Mehrotra More articles by this author , and Rahul Janak SinhaRahul Janak Sinha More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2112AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Vesicouterine fistula (VUF) is a rare cause of female genito-urinary fistula. It comprises 1-4% of all urogenital fistulas. Most of these fistulas occur due to lower segment caesarean section (LSCS). The incidence of VUF is increasing because of increasing prevalence of caesarean section. Traditionally, open surgical repair has been the treatment of choice. However, laparoscopic repair of VUF is a minimally invasive technique and few case reports have been published with short term follow up. In the current study, we are presenting our long- term outcomes of laparoscopic repair of VUF METHODS A retrospective analysis of patients was performed who underwent laparoscopic repair of VUF between 2010 and 2017 after approval of Institutional Review Committee. Nine patients had history of LSCS of whom 3 had history of prolonged obstructed labour and 1 patient had history of dilatation and curettage for medical termination of pregnancy. Radiological imaging included ultrasound of kidney, ureter and bladder for all patients and hysterosalpingography (HSG) in 4 patients and contrast enhanced computed tomography scan in all patients. RESULTS The most common presentation was cyclical menstrual bleeding through urine (menouria) in 9 of 10 patients, associated amenorrhea in 7 and vaginal leakage of urine in 3 cases. Median age of the patient was 28.3 years (range, 22-37), and median postoperative follow up was 2.3 years (range, 1 -4). All patients underwent transperitoneal laparoscopic repair of VUF with successful outcomes (Table-1). The mean operating time was 158.7±16.9 min (range, 135-186 min) with a median blood loss of 100 mL (range, 50-210 mL). All patients were advised not to become pregnant for 1 year following laparoscopic repair. Three patients conceived in follow-up and all delivered normal baby by LSCS CONCLUSIONS Laparoscopic repair of VUF is a safe and effective minimally invasive technique with successful pregnancy in long- term follow up. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1017 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Vishwajeet Singh More articles by this author Sunny goel More articles by this author Seema Mehrotra More articles by this author Rahul Janak Sinha More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Case of uterine scar rupture in the second trimester of pregnancy after preceding caesarean section

Разрыв матки - одно из редких и грозных осложнений беременности и родов. Наиболее часто он встречается в III триместре, однако есть публикации о случаях разрыва матки и во II триместре. В доступной нам отечественной литературе мы не обнаружили публикаций о случаях разрыва матки во II триместре по рубцу после предыдущего кесарева сечения; существующие публикации касались разрыва по рубцу после предшествующей миомэктомии. Частота кесарева сечения и в мире, и в России за последние годы резко возросла, а также появились данные о возможности пролонгирования беременности при разрыве матки по рубцу. Это побудило нас представить собственное клиническое наблюдение. Оно наглядно демонстрирует, что разрыв матки по рубцу на ранних сроках имеет достаточно стёртую картину и довольно часто клиницистами расценивается как угроза прерывания беременности. Необходимо помнить, что для угрозы прерывания беременности характерны укорочение и размягчение шейки матки, чего не происходит при угрожающем или свершившемся разрыве матки по рубцу. Поскольку основными предикторами в решении вопроса пролонгирования беременности в случае разрыва матки по рубцу бывают такие факторы, как время появления симптоматики разрыва матки, срок гестации, локализация плацентации, отсутствие вращения плаценты, жизнеспособность плода, размер имеющегося дефекта, а также характер разрыва, то наибольшее значение приобретает ранняя диагностика этого состояния.

Effect of maternal height on caesarean section and neonatal mortality rates in sub-Saharan Africa: An analysis of 34 national datasets.

RationaleThe lifecycle perspective reminds us that the roots of adult ill-health may start in-utero or in early childhood. Nutritional and infectious disease insults in early life, the critical first 1000 days, are associated with stunting in childhood, and subsequent short adult stature. There is limited or no opportunity for stunted children above 2 years of age to experience catch-up growth. Some previous research has shown short maternal height to lead to adverse birth outcomes. In this paper, we document the association between maternal height and caesarean section, and between maternal height and neonatal mortality in 34 sub-Saharan African countries. We also explore the appropriate height cut-offs to use. Our paper contributes arguments to support a focus on preventing non-communicable risk factors, namely early childhood under-nutrition, as part of the fight to reduce caesarean section rates and other adverse maternal and newborn health outcomes, particularly neonatal mortality. We focus on the Sub-Saharan Africa region because it carries the highest burden of maternal and neonatal ill-health.MethodsWe used the most recent Demographic and Health Survey for 34 sub-Saharan African countries. The distribution of heights of women who had given birth in the 5 years before the survey was explored. We adopted the following cut-offs: Very Short (<145.0cm), Short (145.0–149.9cm), Short-average (150.0–154.9cm), Average (155.0–159.9cm), Average-tall (160.0–169.9cm) and Tall (≥170.0cm). Multivariate logistic regression was used to assess the contribution of maternal stature to the odds ratio of caesarean section delivery, adjusting for other exposures, such as age at index birth, residence, maternal BMI, maternal education, wealth index quintile, previous caesarean section, multiple birth, birth order and country of survey. We also look at its contribution to neonatal mortality adjusting for age at index birth, residence, maternal BMI, maternal education, wealth index quintile, multiple birth, birth order and country of survey.ResultsThere was a gradual increase in the rate of caesarean section with decreasing maternal height. Compared to women of Average height (155.0–159.9cm), taller women were protected. The adjusted odds ratio (aOR) for Tall women was 0.67 (95% CI:0.52–0.87) and for Average-tall women was 0.78 (95% CI:0.69–0.89). Compared to women of Average height, shorter women were at increased risk. The aOR for Short-average women was 1.19 (95% CI:1.03–1.37), for Short women was 2.06 (95% CI:1.71–2.48), and for Very Short women was 2.50 (95% CI:1.85–3.38). There was evidence that compared to Average height women, Very Short and Short women had increased odds of experiencing a neonatal death aOR = 1.95 (95% CI 1.17–3.25) and aOR = 1.66 (95% CI 1.20–2.28) respectively. When we focused on the period of highest risk, the day of delivery and first postnatal day, these aORs increased to 2.36 (95% CI 1.57–3.55) and 2.34 (95% CI 1.19–4.60) respectively. The aORs for the first week of life (early neonatal mortality) were 1.90 (95% CI 1.07–3.36) and 1.83 (95% CI 1.30–2.59) respectively.ConclusionsShort stature is associated with an increased prevalence of caesarean section and neonatal mortality, particularly on the newborn’s first days. These results are even more striking because we know that caesarean section rates tend to be higher among wealthier and more educated women, who are often taller and that the same patterns may hold for neonatal survival; in such cases, adjusting for wealth, education and urban residence would attenuate these associations. Caesarean sections can be lifesaving operations; however, they cost the health system and families more, and are associated with worse health outcomes. We suggest that our findings be used to argue for policies targeting stunting in infant girls and potential catch-up growth in adolescence and early adulthood, aiming to increase their adult height and thus decrease their subsequent risk of experiencing caesarean section and adverse birth outcomes.