Do Breech Presentations in Twins and Singletons Run Different Risks?

1985 ◽  
Vol 34 (3-4) ◽  
pp. 207-211 ◽  
Author(s):  
P. Buekens ◽  
R. Lagasse ◽  
F. Puissant ◽  
F. Leroy
Keyword(s):  
Cesarean Section ◽  
Perinatal Mortality ◽  
Lower Risk ◽  
Breech Presentation ◽  
Fetal Distress ◽  
Mortality Rates ◽  
Apgar Scores ◽  
Significant Difference ◽  
Twin Pregnancies

AbstractWe have compared breech twins and breech single births in a population recorded between 1974 and 1978 in 10 Belgian maternity centers. In 190 twin pregnancies, 38 first and 65 second twins were delivered in breech presentation. These twins were compared to 853 singleton breeches, of which 95 delivered by cesarean section were excluded. Data were stratified according to birthweight. No significant difference between twins and singletons was found in terms of perinatal mortality rates. However, Apgar scores below 7 at 5 minutes were significantly less numerous among first twins than among singletons. Therefore, first twins in breech presentation might be at lower risk of fetal distress. This difference should be taken into account in the management of first twins presenting by the breech.

scholarly journals Retrospective evaluation of attempted vaginal deliveries in dichorionic twin pregnancies

2020 ◽  
Author(s):  
Sabine Enengl ◽  
Peter Oppelt ◽  
Simon-Hermann Enzelsberger ◽  
Philip Sebastian Trautner ◽  
Omar Shebl ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
Time Interval ◽  
Apgar Scores ◽  
Outcome Parameters ◽  
Retrospective Data Analysis ◽  
Vaginal Deliveries ◽  
Mode Of Birth ◽  
Twin Pregnancies ◽  
Second Twin

Abstract Purpose Numbers of planned cesarean deliveries are increasing in twin pregnancies, despite the lack of evidence for this approach, and the second twin is thought to be at risk for a poorer outcome. The aim of this study was to examine whether twins have a poorer outcome if an attempted vaginal delivery is changed to a cesarean section or combined delivery. Methods This retrospective data analysis included all women with dichorionic twin pregnancies attempting vaginal delivery over a 10-year period. Outcome parameters for the first and second twins relative to their mode of birth were compared. A correlation model between the interdelivery time interval and Apgar scores was calculated. Subgroup analyses assessing the birth mode of the first and second twins were conducted. Results A total of 248 women were enrolled in the study. The second twins had significantly lower values for outcome parameters, such as umbilical artery cord pH and Apgar scores in comparison with the first twins (P < 0.01). The subgroup analysis of birth modes in first and second twins showed a significantly poorer outcome in the cesarean section and combined delivery group (P < 0.05). The interdelivery time interval was significantly longer in the second twin cesarean section group (P < 0.01). There was no significant correlation between the interdelivery time intervals and Apgar scores (P > 0.05). Conclusion Although outcome parameters were significantly lower in second twins and twins born via secondary cesarean section, the clinical relevance of this appears to be negligible.

scholarly journals Caesarean section: its rates and indications at a tertiary referral center in Eastern Nepal

1970 ◽  
Vol 9 (3) ◽  
pp. 179-183
Author(s):  
S Chhetri ◽  
U Singh
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Placenta Previa ◽  
Caesarean Section Rate ◽  
Breech Presentation ◽  
Fetal Distress ◽  
Tertiary Referral ◽  
Common Indication ◽  
Tertiary Referral Center ◽  
Referral Center

Background: There has been a sustained increase in the rate of caesarean section in the last few years around the world. Data regarding the current caesarean rate and the trends of its indications in eastern Nepal have not been estimated earlier. Aim: To assess the rate of caesarean sections and the varying indications for caesarean section in a tertiary referral center in eastern Nepal. Methods: All hospital deliveries that took place in BPKIHS between January 2006 and December 2007 were recorded to assess the caesarean section rate and its indications. Results: A total of 5330 deliveries were conducted in 2006. Likewise the total number of deliveries conducted in 2007 was 6634. In 2006 caesarean sections were performed in 28.6% (1524) of all patients. The rate of caesarean sections in 2007 increased and was 33.7% (2239). The most common indication for caesarean section was meconiumstained liquor, which constituted 23.4% (883). The next frequent indication was previous caesarean section, which accounted for 17.2% (650), followed by breech presentation in 11.1% (417), fetal distress in 9.6% (364), non-progress of labor in 7.2% (270), cephalopelvic disproportion in 6.2% (234, and placenta previa in 4.4% (165). Conclusions: There is a increasing trend of performing cesarean section in the tertiary referral center in east era Nepal. The most common indication for cesarean section is meconium-stained liquor. Keywords: Caesarean section; caesarean delivery rates; Nepal DOI: http://dx.doi.org/10.3126/hren.v9i3.5587   HR 2011; 9(3): 179-183

The Second Twin: Retained and Unretained

1995 ◽  
Vol 25 (3) ◽  
pp. 132-133 ◽  
Author(s):  
J I Brian Adinma ◽  
Andy O Agbai
Keyword(s):  
Mortality Rate ◽  
Perinatal Mortality ◽  
Early Recognition ◽  
Remedial Measures ◽  
Apgar Scores ◽  
Perinatal Mortality Rate ◽  
Uterine Inertia ◽  
Comparative Review ◽  
Twin Pregnancies ◽  
Second Twin

In this comparative review of retained and unretained second twins, the commonest causes of retention of the second twins were found to be uterine inertia (48.4%) and obstruction from malpresentation and malposition (32.3%). The pair-presentation most likely to be retained was vertex/transverse. Apgar scores were lower for retained than unretained second twins. The perinatal mortality rate was significantly higher for the retained second twins (258/1000) compared to the unretained second twins (60.2/1000) ( P < 0.002). Early recognition of twin pregnancies in which the 2nd twin is more likely to be retained, and prompt application of appropriate remedial measures would reduce the incidence of retention of the second twin.

scholarly journals The Prenatal Diagnosis~ What should we do? What can we do?

2021 ◽  
pp. 1-7
Keyword(s):  
Diaphragmatic Hernia ◽  
Breech Presentation ◽  
Fetal Distress ◽  
Heart Sounds ◽  
Meconium Peritonitis ◽  
Fetal Hydrops ◽  
Abnormal Pregnancy ◽  
Meconium Staining ◽  
Twin Pregnancies ◽  
Bowel Dilatation

Purpose: Prenatal diagnostic accuracy has improved; however, the pediatric surgeon’s role remains unclear. This paper aimed to determine the prenatal diagnoses made and the role of pediatric surgeons. Methods: A 6-year retrospective review of 904 pregnancies managed at our institute was conducted. They were classified as a normal pregnancy (NP, n=194), abnormal pregnancy maternal factor (MF, n=449), or abnormal pregnancy fetal factor (FF, n=261). Results: In the FF group, the identified conditions were twin pregnancies (n=75), intrauterine growth restriction (IUGR) (n=49), breech presentation (n=26), arrested development (n=19), hypoamnion (n=42), fetal distress (n=16), hydramnios (n=10), abnormal heart sounds (n=5), meconium staining (n=5), surface anomaly (n=4), calcification (n=2), fetal hydrops (n=2), fetal death (n=2), bowel dilatation (n=2), abdominal mass (n=1) and diaphragmatic hernia (n=1). Case of twin pregnancies, breech presentation, arrested development, IUGR, hypoamnion, abnormal heart sounds, meconium staining and fetal hydrops did not require surgery. Of the 16 cases of fetal distress, 1 had biliary atresia. Of the 10 cases of hydramnios, 1 had meconium peritonitis. Of the 4 with surface anomalies, 3 had gastroschisis. Of the 2 with calcification, 1 had meconium peritonitis. Of the two fetal deaths, 1 had anal atresia suggesting a chromosomal abnormality. Of the 2 cases of bowel dilatation, 1 had bowel atresia. The abnormal mass was caused by adrenal bleeding. These diagnoses were made at an average of 27.4 gestational weeks; however, 2 cases of gastroschisis, suggesting a body stalk anomaly; diaphragmatic hernia; and brain cysts were diagnosed before 20 weeks and were aborted. After delivery, the mortality rate was 0% in neonates treated by pediatric surgeons and neonatologists. Conclusion: Fetal abnormalities are rare; however, early aggressive management with the cooperation of obstetricians and parents is crucial for pediatric surgeons to minimize the effects of anomalies.

scholarly journals Evaluation of Factors Affecting Perinatal Mortality in Patients with HELLP Syndrome

2021 ◽  
pp. 1-8
Author(s):  
REYHAN GÜNDÜZ ◽  
SENEM YAMAN TUNÇ ◽  
MEHMET SAİT İÇEN ◽  
SABAHATTİN ERTUĞRUL ◽  
TALİP GÜL
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Perinatal Mortality ◽  
Gestational Age ◽  
Hellp Syndrome ◽  
Neonatal Intensive Care ◽  
Mortality Rates ◽  
Apgar Scores ◽  
Factors Affecting ◽  
Gestational Age At Delivery

OBJECTIVE: To determine the perinatal mortality rate in patients with HELLP syndrome in our clinic and to investigate the factors affecting perinatal mortality. It also makes recommendations to reduce perinatal mortality and contributes to the literature. STUDY DESIGN: Three-hundred-and-eighty-three patients were retrospectively evaluated in this cohort study. The patients' demographic, clinical data, laboratory results, gestational week at delivery, method of delivery, neonatal birth weight, fetal gender, 1- and 5-minute APGAR scores, place of delivery, maternal morbidity, mortality rates, and perinatal mortality rates were recorded. The relationship of these factors with perinatal mortality was investigated. RESULTS: The rate of perinatal mortality was determined as 6%. Patients with HELLP syndrome who experienced perinatal mortality showed significantly lower birth weight, gestational age at delivery, and 1- and 5-minute APGAR score values (p<0.05). With respect to methods of delivery, we determined that vaginal delivery was linked to a significantly higher rate of perinatal mortality (p<0.001). Gestational age at delivery, birth weight, 1- and 5-minute APGAR scores were negatively correlated with perinatal mortality. Logistic regression revealed the APGAR score at 5 minutes as the most reliable independent predictive finding for perinatal mortality. CONCLUSION: We think that to decrease perinatal mortality rates, maternal and fetal well-being in patients with HELLP syndrome should be closely monitored and delivery and follow-up should take place at tertiary health institutions after maternal and neonatal intensive care arrangements are made. Particularly, neonates with low 5-minute APGAR scores in the postpartum evaluation of neonatal condition are recommended to be followed-up at the neonatal intensive care unit.

scholarly journals Comparing the Effects of Low Dose of Ketamine, Tramadol, and Ondansetron in Prevention of Post Spinal Anesthesia Shivering in Cesarean Section

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Ali Mohammadzadeh Jouryabi ◽  
Seyedeh Hajar Sharami ◽  
Mandana Mansour Ghanaie ◽  
Abbas Sedighinejad ◽  
Vali Imantalab ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Gold Standard ◽  
Low Dose ◽  
Demographic Variables ◽  
Double Blind Study ◽  
Double Blind ◽  
Apgar Scores ◽  
Significant Difference ◽  
High Incidence

Background: Shivering frequently occurs in cesarean section (CS) under spinal anesthesia (SA), resulting in several complications. To date, pethidine has been considered as the gold standard for post-SA shivering control, but it is contraindicated in breastfeeding women. Methods: This randomized, double-blind study was conducted at Alzahra hospital in Guilan, Iran, From January 2019 to November 2020. A total of 508 eligible term parturient women were enrolled and randomly divided into four groups of low dose ketamine (K), tramadol (T), ondansetron (O), and placebo (P). The incidence and severity of shivering and patients’ complications were recorded and compared among the groups. Results: The patients were homogenous in terms of demographic variables. Shivering was witnessed in 68 (53.5%), 26 (20.5%), 75 (59.1%), and 82 (64.6%) patients in K, T, O, and P groups, respectively (P = 0.0001). Regarding shivering severity, there was a significant difference among the four groups (P = 0.0001). In addition, a significant difference was seen regarding Apgar scores at the first minute, but not at the fifth minute (P = 0.168). Conclusions: Considering the high incidence of shivering in placebo group, prophylactic intervention in CS under SA seems to be necessary. Among the studied drugs, tramadol was the most effective one, followed by a low dose of ketamine and ondansetron.

scholarly journals COMPARISON OF NEONATAL APGAR SCORES AND PATIENT SATISFACTION LEVELS IN SPINAL VERSUS GENERAL ANESTHESIA IN ELECTIVE CESAREAN SECTIONS

2021 ◽  
Vol 71 (4) ◽  
pp. 1183-87
Author(s):  
Syed Khurram Naseer ◽  
Aijaz Ali ◽  
Shizan Hamid Feroz ◽  
Dr Danish ◽  
Amir Sohail
Keyword(s):  
Patient Satisfaction ◽  
Cesarean Section ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Elective Cesarean Section ◽  
Military Hospital ◽  
P Value ◽  
Apgar Scores ◽  
Significant Difference ◽  
Elective Cesarean

Objective: To compare patients undergoing cesarean section under spinal and general anesthesia in terms of neonatal APGAR scores and patient satisfaction. Study Design: Comparative cross-sectional study. Place and Duration of Study: Departments of Anesthesia and Gynecology and Obstetrics, Combined Military Hospital Peshawar, for six months from Mar to Aug 2019. Methodology: In this study, 120 females with a singleton pregnancy of 36-40 weeks, and requiring a non-emergency elective cesarean section were enrolled through consecutive sampling in the study. The patients were randomly allocated into two equal groups of 60 women each through random table numbers. Group A received spinal anesthesia and group B general anesthesia. APGAR score was assessed at 5 minutes after delivery, and score of ≥7 was taken as satisfactory. Patient's satisfaction level regarding anesthesia was recorded on a visual analogue scale of 0 (extremely unsatisfied) to 10 (completely satisfied), and score of ≥7 was taken as satisfactory. Results: Women receiving general anesthesia were more satisfied as compared to receiving spinal anesthesia (95% vs. 78.3%; p-value 0.007). There was no significant difference in terms of APGAR scores in general anesthesia and spinal anesthesia (83.33% versus 90%; p-value 0.283). Conclusion: After an elective caesarean section, more mothers were satisfied after receiving general anesthesia as compared to spinal anesthesia. However, both types of anaesthesia were found to be equally safe for babies born in terms of APGAR scores at 5 minutes.

A Workbook Exercise on Necrotizing Enterocolitis

1981 ◽  
Vol 3 (4) ◽  
pp. 121-129
Author(s):  
Fredric D. Burg ◽  
Richard A. Polin
Keyword(s):  
Intensive Care ◽  
Cesarean Section ◽  
Necrotizing Enterocolitis ◽  
Umbilical Vein ◽  
Journal Article ◽  
Fetal Distress ◽  
Apgar Scores ◽  
Emergency Cesarean ◽  
Intensive Care Nursery ◽  
Better Than

Readers will immediately notice that the following article departs from the usual style in medical journals. We all recognize that active learning is far better than passive, but this is difficult to achieve in the usual journal article. Drs Burg and Polin have developed a sequential workbook approach in the following article which will require your active participation. We believe that it will result in better learning, but would appreciate reader comment. R.J.H. The following are a series of exercises aimed to help you in: (1) identifying the factors that cause necrotizing enterocolitis (NEC); (2) Explaining the pathophysiology of NEC; (3) developing a proper approach to diagnosing necrotizing enterocolitis in the neonate; and (4) managing a newborn with this disease. EXERCISE 1 Factors That Contribute to Development of Necrotizing Enterocolitis Please read through the following case history. K.W. was a 1,600-gm girl delivered to a 17-year-old primigravida by emergency cesarean section for fetal distress at 31 weeks' gestation. Apgar scores at one and five minutes were 2 and 5. The infant was given 3 mEq of sodium bicarbonate through an umbilical vein (UV) catheter in the delivery room and then intubated. Following admission to the intensive care nursery an umbilical arterial (UA) catheter was inserted and positioned at L-1.

Diagnosis of Placental Position by Early First-Trimester Ultrasound: A Pilot Study

2019 ◽  
Vol 26 (11) ◽  
pp. 1512-1518 ◽  
Author(s):  
Laura Detti ◽  
Jennifer C. Gordon ◽  
Mary E. Christiansen ◽  
Nicole A. Van de Velde ◽  
Ludwig Francillon ◽  
...  
Keyword(s):  
Pilot Study ◽  
Cesarean Section ◽  
Transvaginal Ultrasound ◽  
First Trimester ◽  
Significant Difference ◽  
Gestational Sac ◽  
Twin Pregnancies ◽  
Anterior Posterior ◽  
First Trimester Ultrasound

Objective: Conventional wisdom is that placental location cannot be identified before 8 weeks’ gestation when the placenta first becomes hyperechogenic on ultrasound. We sought to evaluate whether placental location could be reliably diagnosed between 5 and 6 weeks’ gestation. Materials and Methods: This was a retrospective analysis of prospectively acquired data. Early placental location was diagnosed by evaluation of the embryonal and yolk sac position inside the gestational sac on transvaginal ultrasound. Placental position was described as anterior, posterior, fundal, or lateral. Early and mid-pregnancy placental locations were compared and coded as being the same, having migrated to an adjacent surface, or being on an opposite surface. Results: A total of 111 patients met study criteria, providing 141 placental locations, comprising 85 singleton and reduced pregnancies and 28 dichorionic twin pregnancies. The most common placental location was anterior in both singleton and twin/triplet pregnancies. Placental location at the mid-pregnancy ultrasound was consistent with early pregnancy location in 100% of cases, with 79.5% (112/141) being on the same surface and 20.5% (29/141) having expanded onto an adjacent surface. Placental location was not associated with pregnancy outcome, although our study may have been underpowered to detect a significant difference. Conclusions: Placental location diagnosed at 5 to 6 weeks’ gestation is consistent with the location on mid-pregnancy ultrasound. Excluding the presence of an ectopic, cornual, or cesarean section scar and uterine subseptation pregnancy in early first trimester would allow a more effective tailoring of pregnancy follow-up.

scholarly journals Is current rising trends of cesarean section –justified ?

2017 ◽  
Vol 6 (3) ◽  
pp. 872 ◽  
Author(s):  
. Preetkamal ◽  
Harmanpreet Kaur ◽  
Madhu Nagpal
Keyword(s):  
Cesarean Section ◽  
Tertiary Care ◽  
Breech Presentation ◽  
Fetal Distress ◽  
Antenatal Clinic ◽  
Similar Rate ◽  
Cesarean Section Rate ◽  
Early Labour ◽  
Group 5 ◽  
Tertiary Care Centers

Background: Cesarean section has become more prevalent over the years due to various factors and is exceeding the tolerable limit specified by WHO. The objective of this study was to analyze cesarean section rates in our department and to identify the factors that contributed to rising cesarean section rate considering both institutional aspects as well as socioeconomic causes.Methods: It was a retrospective study conducted between May 2015 to April 2016 and included all pregnant patients booked in antenatal clinic and unbooked patients admitted in early labour in whom cesarean section was conducted later along with cases coming in emergency for which cesarean section was indicated. Data was collected and categorized on the basis of age, parity, socioeconomic status, education and according to Robson’s ten group classification.Results: The cesarean section rate was found to be 33.2% in our study. The most common indication was repeat cesarean section, fetal distress, and breech presentation. Robson’s group1 had maximum cesarean rates followed by group 5, 6 and 3.Conclusions: Tertiary care centers cannot be expected to have a similar rate as primary and secondary ones due to high number of complex cases referred to them. Though effort should be made to keep the cesarean rate at a low level as suggested by WHO but denying it for an indicated case just to adhere to keep low rate jeopardizes maternal and fetal health. Hence no definitive guidelines can be followed and a very judicious approach is needed.

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