DIAGNOSIS AND MANAGEMENT OF ITP DURING THE PERINATAL PERIOD

1987 ◽  
Author(s):  
G C M L Christiaens
Keyword(s):  
Caesarean Section ◽  
Vaginal Delivery ◽  
Randomized Study ◽  
Elective Caesarean Section ◽  
Corticosteroid Treatment ◽  
Perinatal Period ◽  
Current Data ◽  
Mortality And Morbidity ◽  
Breech Delivery ◽  
Platelet Counts

Although maternal and perinatal mortality and morbidity in pregnant patients with ITP are lower than previously assumed, they are not negligable. Significant postpartum hemorrhage occurs in 7% of the mothers with ITP. Thrombocytopenia is found in 51% of the newborns born from mothers with ITP and 6% of these have serious bleeding problems. Tests which predict which fetuses are at risk, are not yet available. Thrombocyte counts in a fetal blood sample are falsely low in 40% of cases.A prospective controlled randomized study done in the Netherlands failed to show an effect of antenatal corticosteroid treatment on neonatal platelet counts. Elective caesarean section has not been shown to protect against intracranial bleeding in thrombocytopenic newborns. The choice between vaginal delivery and caesarean section in ITP patients should be made on obstetric grounds with one exception: no other assisted vaginal delivery than the easy outlet forceps should be done. All cases of slow progress of the second stage of labour with insufficient descent should be terminated by caesarean section as well as breech delivery with suboptimal progress. Newborn thrombocyte counts should be done daily during the first week of life, since lowest platelet counts are often found between the 3rd and 5th postpartum day. Newborn thrombocytopenia is transient and does not warrant splenectomy, but can necessitate treatment with corticosteroids and/or high doses of immunoglobulin 6. Current data do not justify to dissuade breastfeeding.The recurrence of neonatal thrombocytopenia in subsequent patients is unknown.

scholarly journals Spontaneous Vaginal Delivery after Three Previous Caesarean Sections

2018 ◽  
Vol 1 (1) ◽  
pp. 120-124
Author(s):  
Hani Shams Eldin ◽  
Nicholas Oligbo
Keyword(s):  
Caesarean Section ◽  
Vaginal Delivery ◽  
Uterine Rupture ◽  
Elective Caesarean Section ◽  
Vaginal Birth ◽  
Spontaneous Vaginal Delivery ◽  
Mortality And Morbidity ◽  
Risk Increase ◽  
Wheel Chair ◽  
Uterine Scar

Women with one previous caesarean section have 0.05% risk of uterine rupture, with two caesarean sections the risk increase to 1.36%. We could not find data on the risk of uterine rupture after three caesarean sections. Elective caesarean section is therefore offered to these women by their clinical professionals to eliminate the risk. However, we report a case of spontaneous vaginal delivery with an intact uterine scar in a woman with a previous three caesarean sections to show the possibility of vaginal birth in patients with repeated caesarean section. A 32-year-old female in her 4th pregnancy with previous three caesarean section 1st two emergencies and 3rd elective (Gravida 4, para 3) presented to the delivery suite in spontaneous labour at 39 weeks and 3 days with vaginal bleeding. Emergency call gone off and patient was transferred immediately to theatre, during transfer she pushed down while she was on the wheel chair and the baby head found to be delivered vaginally. A live healthy baby girl weighing 2590 g was delivered. The patient had Postpartum bleeding of 500 ml and 2nd degree perineal and labial tears; the patient was discharged home fit and well on day one postpartum. Repeated caesarean section increases maternal mortality and morbidity. Vaginal birth after repeated previous caesarean sections could still be an option in selected cases as safe vaginal delivery has been reported.

scholarly journals VAGINAL BREECH DELIVERY

2015 ◽  
Vol 22 (08) ◽  
pp. 1024-1028
Author(s):  
Samina Naz
Keyword(s):  
Caesarean Section ◽  
Vaginal Delivery ◽  
Perinatal Death ◽  
Elective Caesarean Section ◽  
Breech Presentation ◽  
Neurological Dysfunction ◽  
Breech Delivery ◽  
Vaginal Breech Delivery ◽  
Group A ◽  
Group B

Objective: To determine the obstetric and perinatal outcome of pregnancieswith singleton breech presentation, and to scrutinize the causes of increasing incidence ofcesarean section in breech presentation. Design: Analytical Observational study. Place andduration: Department of obstetrics and gynecology Fatima hospital Baqai university campusfrom Jan 2010 to Oct 2011. Patients & Methods: This study includes 135 patients with singletonbreech presentation ≥ 34 weeks of gestation, were analyzed in detail with help of designedperforma. Patients were categorized in three groups. Groups a, who had elective C-section,group b. who underwent emergency caesarean section or had C-section after failed trial ofvaginal delivery and group c. who had vaginal breech delivery. Elective caesarean section wasdone in those cases that had some other indications for carrying out this procedure apart frombreech presentation. Trial of vaginal breech delivery was planned for all multiparous womenexcept those falling in group A. All antepartum fetal demise, twin pregnancies and placentaprevia of major degree were excluded. Results: Of 135 women, 7(5%) underwent prelabourcesarean, and 128(95%), had trial of vaginal delivery, of whom 117(91.5%) delivered vaginally.Significantly more infants weighing> 3.5kg were selected for prelabour and intrapartumcesarean than vaginal delivery. Two neonates had Apgar score< 7 at 5 minutes but both werenormal neurologically. There were no nonanomalous perinatal death and no case of significanttrauma or neurological dysfunction. Two infants died due to lethal anomalies. Conclusion:Trial of vaginal breech delivery in well counselled patients, still taken as an appropriate optionwithout compromising prenatal and maternal outcome. It also decreases the rate of cesareansection.

scholarly journals Pregnancy Outcome of Single Previous cesarean Section

1970 ◽  
Vol 7 (1) ◽  
pp. 25-28 ◽  
Author(s):  
M Jha
Keyword(s):  
Caesarean Section ◽  
Vaginal Delivery ◽  
Apgar Score ◽  
Postpartum Hemorrhage ◽  
Elective Caesarean Section ◽  
Previous Caesarean Section ◽  
Cephalopelvic Disproportion ◽  
Main Indication ◽  
Assisted Delivery ◽  
Vacuum Delivery

Background: The main aim of this study is to determine the maternal and fetal outcome of pregnancy among women with one previous caesarean section at term in relation to vaginal delivery, post partum complication, neonatal complication like low Apgar score, fetal weight and admission in special baby unit. Methods: This is a prospective and descriptive study done in a sample size of 100. Inclusion criteria were term pregnancy, single live fetus with cephalic presentation with one previous caesarean section. During study period total number of obstetric admissions was 3546 and 115 cases were admitted with previous one caesarean section. Result: Out of 100 cases, 31 cases had vaginal delivery and 69 cases had caesarean section. Among 31 vaginal deliveries, 24 cases had spontaneous vaginal delivery and 7 had assisted delivery with vacuum, main indication of vacuum delivery was to cut short the second stage of labor that was in 5(71.43%) cases. Among 69 caesarean section cases, 51 had emergency caesarean section and 18 had elective caesarean section and cephalopelvic disproportion was the main indication in both the groups. Most common complication was scar dehiscence and postpartum hemorrhage. There were two still births in each group and one minute APGAR score was slightly better in caesarean section. Conclusions: Patients with previous caesarean section are at high risk of repeat emergency or elective caesarean section. About one in three patients with previous caesarean section delivered vaginally. In the present study postpartum hemorrhage was the commonest complication, which was found in caesarean section, and only  one puerperal pyrexia was seen in case of vaginal delivery. Key words: Cephalopelvic disproportion, Premature rupture of membrane, Septicemia, Vacuum delivery   DOI: 10.3126/jnhrc.v7i1.2275 Journal of Nepal Health Research Council Vol. 7, No. 1, 2009 April 25-28

scholarly journals Postpartum quality of life after normal vaginal delivery and caesarean section

2015 ◽  
Vol 2 (2) ◽  
pp. 13-18
Author(s):  
Yogendra Amatya ◽  
Samita Acharya
Keyword(s):  
Quality Of Life ◽  
Caesarean Section ◽  
Vaginal Delivery ◽  
Elective Caesarean Section ◽  
Family Type ◽  
Normal Vaginal Delivery ◽  
Cross Sectional ◽  
Normal Delivery ◽  
Physical Health Composite Score

Introductions: Caesarean section is rising. The best method of delivery, vaginal or caesarean, for postpartum quality of life in women is a matter of controversy both from professionals’ perspectives and from women’s experience of childbirth. This study analyses quality of life after these two methods of deliveries.Methods: This was a cross-sectional comparative study in postnatal care outpatient department at Patan Hospital. Primipara women with normal delivery and elective caesarean section done in Patan Hospital were enrolled to analyse postpartum quality of life. The SF-12 questionnaire tool at 6 weeks post delivery was used to compare age, ethnicity, education, family type and employment. Data was analysed using ANOVA test for descriptive parameters.Results: There were 468 primipara, age 30-45 years, 94% in 15-30 years77.8% educated, 74.4% in joint family,73.5% housewife. Normal vaginal delivery was 360 (72.6%) and 128 (27.4%) elective caesarean. Vaginal delivery group had average SF score of Physical Health Composite Score of 68.7, Mental Health CompositeScore69.5 and total SF score 67.7. While in caesarean group, it was 64.8,64.1 and 63.4.Conclusions: Normal vaginal delivery had better quality of life resulting in both superior physical as well as mental health.Journal of Patan Academy of Health Sciences, Vol. 2, No. 2, 2015. page:13-18

scholarly journals Vaginal Delivery versus Elective Caesarean Section for Breech Presentation - Experience in Institute of Child and Mother Health (ICMH)

2019 ◽  
Vol 31 (1) ◽  
pp. 23-26
Author(s):  
Mahe Jabeen ◽  
Sabiha Shimul ◽  
Ummay Salma ◽  
Jebunnesa
Keyword(s):  
Caesarean Section ◽  
Vaginal Delivery ◽  
Maternal Morbidity ◽  
Neonatal Outcome ◽  
Elective Caesarean Section ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Breech Presentation ◽  
Cost Of Care ◽  
Increased Risk

Introduction: Compared with a fetus with cephalic presentation, a breech fetus faces increased risk during labour and delivery of asphyxia from cord compression and of traumatic injury during delivery of the shoulders and head. Caesarean section avoids most of this risk. The purpose of this study was to evaluate the feasibility of vaginal delivery of uncomplicated singleton breech presentation by evaluating early neonatal morbidity and mortality as well as maternal morbidity following vaginal and caesarean delivery for breech presentation. Materials and Methods: This is a cross sectional comparative study.104 women with singleton breech presentation at term in labour were included consequetively in labour ward of Institute of Child and Mother Health (ICMH). Informed consent was taken from them. Neonatal and maternal outcome were recorded and statistical analysis was done using SPSS version 22. Results: APGAR at 5 min and Neonatal Intensive Care Unite (NICU) admission were not affected by mode of delivery. Long term neonatal outcome is similar in either mode of delivery. Maternal morbidity and duration of hospital stay is increased in caesarean births. Conclusion: Neonatal outcome did not depend on mode of delivery though maternal morbidity and cost of care is increased following Caesarean Section. Proper selection of cases and by improving skill & confidence in new generation obstetrician, vaginal delivery of singleton fetuses in breech presentation at term remains a safe option that can be offered to a woman in a tertiary care centre. Medicine Today 2019 Vol.31(1): 23-26

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