Prenatal Diagnosis of Vasa Previa: Outpatient versus Inpatient Management

2018 ◽  
Vol 36 (04) ◽  
pp. 422-427
Author(s):  
Baha Sibai ◽  
Hadas Ilan ◽  
Sharon Katz ◽  
Irit Schushan Eisen ◽  
Eran Kassif ◽  
...  
Keyword(s):  
Prenatal Diagnosis ◽  
Cesarean Section ◽  
Management Strategies ◽  
Elective Cesarean Section ◽  
Antenatal Steroids ◽  
Outpatient Group ◽  
Tertiary Center ◽  
Vasa Previa ◽  
Elective Cesarean ◽  
Inpatient Group

Objective The aim of this study was to compare the pregnancy outcome of two different management strategies: outpatient versus inpatient in women with prenatal diagnosis of vasa previa. Materials and Methods This is a retrospective cohort study conducted at a single tertiary center. Women with a prenatally diagnosed vasa previa between January 2007 and June 2017 were included. Obstetric and neonatal outcomes were compared between two management strategies: elective admission at 34 weeks of gestation or outpatient management unless there were signs of labor or premature contractions. Results A total of 109 women met the inclusion criteria: 75 (68.8%) women in the inpatient group and 34 (31.2%) in the outpatient group. Women in the inpatient group were more likely to receive antenatal steroids (57.3 vs. 26.4%, p = 0.002) and were less likely to have an urgent cesarean section (34.6 vs. 58.8%, respectively, p < 0.001) compared with outpatient group. There was no difference in the rate of neonatal complications (inpatient: 64.6% vs. outpatient: 52.7%, p = 0.27) or neonatal anemia requiring transfusion (2.7 vs. 5.8%, respectively, p = 0.5) between the groups. Conclusion The rate of elective cesarean section and exposure to antenatal steroids was higher in patients with vasa previa who were admitted electively at 34 weeks of gestation compared with patients who were managed as outpatient.

scholarly journals A close call: does the location of incision at cesarean delivery matter in patients with vasa previa? A case report.

F1000Research ◽  
2013 ◽  
Vol 2 ◽  
pp. 267 ◽  
Author(s):  
Werner M Neuhausser ◽  
Laxmi V Baxi
Keyword(s):  
Case Report ◽  
Cesarean Section ◽  
Post Partum ◽  
Elective Cesarean Section ◽  
Second Trimester ◽  
Uterine Incision ◽  
Vasa Previa ◽  
Close Call ◽  
Elective Cesarean ◽  
Utmost Care

We present here a case of vasa previa in a multipara, diagnosed at the time of her late second trimester ultrasonogram. The patient subsequently underwent an elective cesarean section after 37 weeks gestation, giving birth to a healthy child with an uneventful post-partum, neonatal and infant course. At the time of cesarean section, the incision was gradually deepened in layers through the myometrium by utmost care allowing the amniotic sac to protrude through the uterine incision hereby avoiding laceration of the vasa previa and its branches. Fetal exsanguination and a need for blood transfusion as well as a possible adverse neonatal course were therefore avoided.

scholarly journals Improving Neonatal and Maternal Outcome by Inducing Mild Labor before Elective Cesarean Section: The Lacarus Randomized Controlled Trial

Neonatology ◽  
2021 ◽  
pp. 1-6
Author(s):  
Sven Wellmann ◽  
Gwendolin Manegold-Brauer ◽  
Tina Fischer ◽  
Leonhard Schäffer ◽  
Vincent D. Gaertner ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Challenge Test ◽  
Well Being ◽  
Current Evidence ◽  
Elective Cesarean Section ◽  
Respiratory Morbidity ◽  
Uterine Contractions ◽  
Antenatal Steroids ◽  
Breastfeeding Rate ◽  
Elective Cesarean

<b><i>Background:</i></b> Newborns delivered by elective cesarean section (CS) are at higher respiratory risk than those delivered vaginally or by CS proceeded by labor (secondary CS). The oxytocin challenge test (OCT) induces uterine contractions that trigger the release of fetal hormones regulating lung fluid clearance during transition from the uterine to an air-breathing environment. <b><i>Objectives:</i></b> The aim is to summarize current evidence and outline the Lacarus trial protocol. <b><i>Methods:</i></b> Literature review informed the design of a randomized placebo-controlled multicenter trial of OCT preceding elective CS in 1,450 women with a singleton pregnancy due for CS at &#x3e;35 weeks gestation, without preceding contractions, rupture of the membranes, or antenatal steroids. OCT comprises the infusion of oxytocin 5 IU/500 mL Ringer lactate at a rate of 12 mL/h, doubling every 10 min until inducing 5 uterine contractions per 15-min interval. The primary endpoint is the occurrence of neonatal respiratory morbidity within 24 h after birth. Secondary endpoints include biochemical and physiological parameters of fetal and maternal well-being, such as breastfeeding rate and fetal plasma copeptin concentrations. <b><i>Conclusion:</i></b> This is the first trial to test the hypothesis that oxytocin-induced contractions before elective CS is a promising application of physiologic principles gleaned from natural birth to improve neonatal and maternal outcomes.

Management of vasa previa during pregnancy

2015 ◽  
Vol 43 (6) ◽  
Author(s):  
Junichi Hasegawa ◽  
Tatsuya Arakaki ◽  
Kiyotake Ichizuka ◽  
Akihiko Sekizawa
Keyword(s):  
Present Report ◽  
Management Strategies ◽  
Cervical Length ◽  
Elective Cesarean Section ◽  
Fetal Mortality ◽  
Uterine Contractions ◽  
Membrane Rupture ◽  
Asymptomatic Patients ◽  
Vasa Previa ◽  
Elective Cesarean

AbstractIn order to prevent fetal mortality due to vasa previa, it is neceesary to obtain an antenatal diagnosis and perform elective cesarean section prior to membrane rupture. Under present circumstances, management strategies for vasa previa depend on each institutional policy. In our institution, patients are not routinely admitted, although precise outpatient management, including confirming the presence of uterine contractions and monitoring the cervical length, fetal growth and fetal heart rate, is provided for pregnant females with vasa previa. In the present report, we reviewed 21 cases of vasa previa managed at our hospital. Some 71% (15/21) of them were required inpatient management due to its complications, resulting in emergency delivery in about half of them. Therefore, our results suggest that only carefully selected asymptomatic patients may be successfully managed as outpatients.

Acute Dystonia after a Single Dose of Intravenous Metoclopramide during Elective Cesarean Section: A Case Report.

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Danielle Levin
Keyword(s):  
Single Dose ◽  
Case Report ◽  
Cesarean Section ◽  
Epidural Anesthesia ◽  
Elective Cesarean Section ◽  
Single Administration ◽  
Dystonic Reaction ◽  
Elective Cesarean ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural

We would like to present the first report of severe acute dystonic reaction after a single administration of metoclopramide during cesarean section under combined spinal-epidural anesthesia.  During elective cesarean section, a 30-year-old female vomited four times and was treated with 10mg intravenous metoclopramide and 8mg intravenous ondansetron.  Nausea subsided with the antiemetic treatment, but two minutes later, patient had rapid eye blinking, uncontrollable head movement, and became unresponsive.  Bolus of 50mg intravenous diphenhydramine resolved the acute dystonic symptoms within seconds.  Patient was again oriented times three, with no recollection of symptoms, and remained symptom free for the rest of admission. 

scholarly journals Women’s empowerment and elective cesarean section for a single pregnancy: a population-based and multivariate study in Vietnam

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Myriam de Loenzien ◽  
Quoc Nhu Hung Mac ◽  
Alexandre Dumont
Keyword(s):  
Cesarean Section ◽  
Partner Violence ◽  
Negative Impact ◽  
Mode Of Delivery ◽  
Women's Empowerment ◽  
Women’S Empowerment ◽  
Elective Cesarean Section ◽  
Multiparous Women ◽  
Elective Cesarean ◽  
Primiparous Women

Abstract Background Women’s empowerment, and maternal and neonatal health are important targets of the Sustainable Development Goals. Our objective is to examine the relationship between women’s empowerment and elective cesarean section (ECS), focusing on Vietnam, a country where the use of CS has increased rapidly in recent decades, which raises public health concerns. Methods We hypothesized that in the context of the developing biomedicalization of childbirth, women’s empowerment increases the use of ECS due to a woman’s enhanced ability to decide her mode of delivery. By using microdata from the 2013–2014 Multiple Indicator Clusters Survey, we conducted a multivariate analysis of the correlates of ECS. We studied a representative sample of 1343 institutional single birth deliveries. Due to higher ECS rates among multiparous (18.4%) than primiparous women (10.1%) and the potential interaction between parity and other correlates, we used separate models for primiparous and multiparous women. Results Among the indicators of women’s external resources, which include a higher level of education, having worked during the previous 12 months, and having one’s own mobile phone, only education differed between primiparous and multiparous women, with a higher level among primiparous women. Among primiparous women, no resource indicator was significantly linked to ECS. However, considering women’s empowerment facilitated the identification of the negative impact of having had fewer than 3 antenatal care visits on the use of ECS. Among multiparous women, disapproval of intimate partner violence (IPV) was associated with a doubled likelihood of undergoing ECS (odds ratio = 2.415), and living in an urban area also doubled the likelihood of ECS. The positive association with living in the richest household quintile was no longer significant when attitude towards IPV was included in the model. In both groups, being aged 35 or older increased the likelihood of undergoing ECS, and this impact was stronger in primiparous women. Conclusions These results underline the multidimensionality of empowerment, its links to other correlates and its contribution to clarifying the influence of these correlates, particularly for distinguishing between medical and sociocultural determinants. The results advocate for the integration of women's empowerment into policies aimed at reducing ECS rates.

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