Cesarean Birth Morbidity among Women with SARS-CoV-2

2021 ◽  
Author(s):  
Rodney McLaren ◽  
Viktoriya London ◽  
Sujatha Narayanamoorthy ◽  
Fouad Atallah ◽  
Michael Silver ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Surgical Outcomes ◽  
Primary Outcome ◽  
Postoperative Fever ◽  
Cesarean Birth ◽  
Estimated Blood Loss ◽  
Increased Risk ◽  
Key Points ◽  
Significant Difference ◽  
Cesarean Births

Objective The objective of this study was to compare maternal outcomes of women with and without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections who underwent cesarean births. Study Design This was a matched cohort study of pregnant women who had a cesarean birth between March 15, 2020, and May 20, 2020. Cases included women who tested positive for SARS-CoV-2. For every case, two patients who tested negative for SARS-CoV-2 were matched by maternal age, gestational age, body mass index, primary or repeat cesarean birth, and whether the procedure was scheduled or unscheduled. We compared rates of adverse postcesarean complications (intraoperative bladder or bowel injury, estimated blood loss more than or equal to 1,000 mL, hemoglobin drop more than 3 g/dL, hematocrit drop more than 10%, need for blood transfusion, need for hysterectomy, maternal intensive care unit admission, postoperative fever, and development of surgical site infection), with the primary outcome being a composite of those outcomes. We also assessed duration of postoperative stay. Fisher's exact tests were performed to compare the primary outcome between both groups. Results Between March and May 2020, 202 women who subsequently underwent cesarean birth were tested for SARS-CoV-2. Of those 202, 43 (21.3%) patients were positive. They were matched to 86 patients who tested negative. There was no significant difference in the rate of composite adverse surgical outcomes between the groups (SARS-CoV-2 infected 27.9%, SARS-CoV-2 uninfected 25.6%; p = 0.833). There was a higher rate of postoperative fevers (20.9 vs. 5.8%; p = 0.015), but that did not result in a longer length of stay (p = 0.302). Conclusion Pregnant women with SARS-CoV-2 who underwent a cesarean birth did not have an increased risk of adverse surgical outcomes, other than fever, compared with pregnant women without SARS-CoV-2. Key Points

scholarly journals Why do pregnant women prefer cesarean birth? A qualitative study in a tertiary care center in Southern Thailand

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chitkasaem Suwanrath ◽  
Sopen Chunuan ◽  
Phawat Matemanosak ◽  
Sutham Pinjaroen
Keyword(s):  
Qualitative Study ◽  
Pregnant Women ◽  
Risk Perceptions ◽  
Care Center ◽  
Tertiary Care ◽  
Cesarean Birth ◽  
Positive Attitudes ◽  
Cesarean Births ◽  
Medical Indications ◽  
Superstitious Beliefs

Abstract Background Increasing worldwide rates of cesarean section are of global concern. In recent years, cesarean births upon maternal request have become a hotly debated issue. Hence, this study aimed to explore maternal reasons for cesarean preference without medical indications. Methods A descriptive qualitative study was conducted, using in-depth interviews with 27 pregnant women who preferred cesarean birth, attending antenatal care in Songklanagarind Hospital from September 2018 to June 2019. Data were analyzed using content analysis. Results Maternal reasons for cesarean preference were classified into six main categories: fear of childbirth, safety concerns related to health risk perceptions, negative previous birth experiences, positive attitudes toward cesarean birth, access to biased information and superstitious beliefs in auspicious birth dates. Most women had more than one reason for opting cesarean birth. Conclusion Several reasons for cesarean birth preference have been elucidated. One striking reason was superstitious beliefs in auspicious birth dates, which are challengable for obstetricians to deal with. Obstetricians should explore the exact reasons why women request cesarean birth in order to prevent or diminish unnecessary cesarean births.

scholarly journals Impact of Endometriomas and Deep Infiltrating Endometriosis on Pregnancy Outcomes and on First and Second Trimester Markers of Impaired Placentation

Medicina ◽  
2019 ◽  
Vol 55 (9) ◽  
pp. 550
Author(s):  
Carolina Scala ◽  
Umberto Leone Roberti Maggiore ◽  
Fabio Barra ◽  
Matteo Tantari ◽  
Simone Ferrero
Keyword(s):  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Demographic Data ◽  
Perinatal Outcomes ◽  
First Trimester ◽  
Deep Infiltrating Endometriosis ◽  
Deep Endometriosis ◽  
Birth Prevalence ◽  
Increased Risk ◽  
Significant Difference

Background and objective: Previous studies did not draw a definitive conclusion about the influence of the role of deep endometriosis (DE) and ovarian endometrioma (OE) as risk factor for developing adverse perinatal outcomes in patients affected by endometriosis. This study aimed to investigate if adverse fetal and maternal outcomes, and in particular the incidence of small for gestational age (SGA) infants, are different in pregnant women with OE versus pregnant women with DE without OE. Material and methods: This study was based on a retrospective analysis of a database collected prospectively. The population included in the study was divided into three groups: patients with OE, patients with DE without concomitant OE, and patients without endometriosis (controls). The controls were matched on the basis of age and parity. Demographic data at baseline and pregnancy outcomes were recorded. Results: There was no statistically significant difference in first trimester levels of PAPP-A, first and mid-pregnancy trimester mean Uterine Artery Doppler pulsatile index, estimated fetal weight centile, and SGA fetuses’ prevalence for patients with OE, and those with DE without OE in comparison to health women; moreover, there was no statistically significant difference with regard to SGA birth prevalence, prevalence of preeclampsia, and five-minute Apgar score between these three groups. Conclusions: The specific presence of OE or DE in pregnant women does not seem to be associated with an increased risk of delivering an SGA infant. These data seem to suggest that patients with endometriosis should be treated in pregnancy as the general population, thus not needing a closer monitoring.

scholarly journals Thrombin Generation in Chinese Pregnant Women and the Effect of Insulin Use on Thrombin Generation in Patients with GDM

2019 ◽  
Vol 25 ◽  
pp. 107602961986349
Author(s):  
Feng Dong ◽  
Longhao Wang ◽  
Chengbin Wang
Keyword(s):  
Blood Glucose ◽  
Pregnant Women ◽  
Thrombin Generation ◽  
First Trimester ◽  
Normal Pregnancy ◽  
Third Trimester ◽  
Control Blood Glucose ◽  
Normal Ranges ◽  
Increased Risk ◽  
Significant Difference

Pregnancy is a hypercoagulable state associated with an increased risk of venous thrombosis. Calibrated automated thrombogram (CAT) is a test to monitor the thrombin generation (TG), a laboratory marker of thrombosis risk, and increases during normal pregnancy, but it is still unclear whether TG is related to the use of insulin in pregnant women with gestational diabetes mellitus (GDM). We performed thrombin generation by CAT on 135 normal pregnant women, including 43 in first trimester, 32 in second trimester, 60 in third trimester, respectively; 68 pregnant women with GDM were also enrolled, 19 patients with GDM using insulin to control blood glucose and 49 patients control their blood glucose through diet and exercise with noninsulin treatment. The overall CAT parameters were calculated using descriptive statistics method with mean ± standard deviation. Mean endogenous thrombin potential, peak thrombin generation, and StartTail time increased significantly with the pregnancy. There was no significant difference in TG test parameters except StartTail time( P = .003) in insulin-treated GDM group when compared to those without insulin in the GDM group. The normal ranges for CAT parameters in pregnant women were determined. Thrombin generation increased significantly in first trimester and remains stable in second and third trimester. The use of insulin in patient with GDM did not affect thrombin generation test. Our study helps to establish the reference range of thrombin generation in Chinese normal pregnant population and provide more basis to predict the risk of thrombus complicating during pregnancy.

The comparison of USG measured cervical length in pregnant women with previous induced abortion versus those who have not had an induced abortion

2019 ◽  
Vol 8 (10) ◽  
pp. 4024
Author(s):  
Harshita Naidu ◽  
Nivedita Hegde ◽  
Anjali M. ◽  
Rohini Kanniga ◽  
Akhila Vasudeva
Keyword(s):  
Pregnant Women ◽  
Preterm Delivery ◽  
Transvaginal Ultrasound ◽  
Induced Abortion ◽  
Cervical Length ◽  
Care Hospital ◽  
Spontaneous Preterm Delivery ◽  
Increased Risk ◽  
Significant Difference ◽  
History Of

Background: The majority of women who undergo induced abortion are young and of low parity. Hence, it is desirable to look for any association effects of induced abortion with future reproductive outcomes. In this study, we aim to compare ultrasound measured cervical length in pregnant women with previous induced abortion versus those who have not had an induced abortion.Methods: This was a prospective observational study performed at tertiary care hospital. Total of 400 patients were recruited, divided into two groups. Patients with an induced abortion in previous pregnancy were included as cases and those with no history were taken as controls. Cervical length was measured by transvaginal ultrasound in all participants at 11-14, 18-22 and 28-32 weeks. Pregnancies were followed up to note incidence of spontaneous preterm delivery, preterm pre labour rupture of membranes (PPROM), threatened preterm, and second trimester miscarriage.Results: Authors have found that there was no significant difference in the cervical length of pregnant patients with or without a history of prior induced abortions.  In our study authors found that mean cervical length at 11-14weeks, 18-22 weeks, and 28-32 weeks was 3.47±0.126cm and 3.48±0.195cm; 3.44±0.296cm and 3.49±0.182cm; 3.36±0.477cm and 3.42±0.310cm respectively among cases and controls. However, there was a demonstrably increased risk of spontaneous preterm delivery, PPROM and threatened preterm in patients with a history of prior induced abortion.Conclusions: Authors conclude that previous induced abortion increases the risk of threatened preterm, PPROM, spontaneous preterm delivery in the subsequent pregnancy. But, this risk is not predictable by measuring cervical length as the mean cervical length remained the same in both the groups.

Robotic-assisted Ivor-Lewis esophagectomy in the elderly patient.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 93-93
Author(s):  
Andrea M. Abbott ◽  
Tobin Joel Crill Strom ◽  
Nadia Saeed ◽  
Ravi Shridhar ◽  
Sarah E. Hoffe ◽  
...  
Keyword(s):  
Blood Loss ◽  
The Elderly ◽  
Separate Analysis ◽  
Ivor Lewis ◽  
Robotic Assisted ◽  
Ivor Lewis Esophagectomy ◽  
Estimated Blood Loss ◽  
Increased Risk ◽  
Significant Difference ◽  
The Impact

93 Background: Esophageal cancer continues to increase in incidence worldwide with the age of diagnosis continuing to move towards an older onset. Robotic assisted approaches to esophagectomy have demonstrated decreased complications and length of hospitalization (LOH). We sought to examine the impact of age on outcomes in patients undergoing robotic assisted esophagectomy (RAIL). Methods: From 2009-2013, we identified patients undergoing robotic assisted Ivor Lewis esophagectomy. Patients were then stratified according to 3 age groups. Cohort 1, age less then 50, cohort 2, age 50-70, and cohort 3 >70. Statistical comparisons between LOH, operative time (OT), estimated blood loss (EBL), adverse events (AE) and mortality were made with Kruskal-Wallis and Chi-square tests. Results: We identified 134 patients who underwent RAIL and found no statistically significant difference between the three cohorts for OT, LOH, days spent in intensive care, AE or mortality. There was a difference in EBL with higher median blood loss (150 cc) seen in cohort 1 (50-600cc) and 3 (50-400cc) compared to cohort 2 (100 cc, (25-400cc)), p < 0.01. The most common AE were arrhythmia and pneumonia but this was not significantly different between the cohorts. The overall AE rate was 10% (cohort 1), 21% (cohort 2), 34% (cohort 3), p=0.14. There were 4 leaks (p =0.38) and 2 deaths (p=0.90) in the entire cohort. A separate analysis was done to compare elderly (>70) to the non-elderly (<70). Median EBL was higher in the elderly cohort (100cc (25-600) vs 150cc (50-400), p <0.01). There was a trend towards longer LOH in the elderly (9 (4-35) vs 11 (6-38) days, p =0.06). AE and mortality were not significantly different, although there was a trend toward increased AE (19.8% vs 34%, p=0.07) in the elderly, with arrhythmia being the most common AE. Conclusions: RAIL is a safe surgical technique for use in an aging patient population. We demonstrated there was no increased risk of LOH, AE or death in the elderly patients compared to their younger cohort.

scholarly journals COMBINATION OF PRENATAL GENTLE YOGA EXERCISES AND LAVENDER AROMATERAPY INHALATION TO IMPROVING SLEEP QUALITY IN TRIMESTER III PREGNANT WOMEN

2021 ◽  
Vol 5 (1) ◽  
pp. 42
Author(s):  
Shinta Wurdiana Rhomadona ◽  
Dianita Primihastuti
Keyword(s):  
Sleep Quality ◽  
Pregnant Women ◽  
Sleep Disturbances ◽  
Control Group ◽  
Mild Stress ◽  
Quality Of Sleep ◽  
A Value ◽  
Increased Risk ◽  
Significant Difference

As gestational age increases, the quality of sleep can decrease. It was reported that about 60% of late trimester pregnant women experience fatigue and> 75% experience sleep disturbances. However, these complaints are often ignored, even though it can lead to an increased risk of gestational hypertension, diabetes, prematurity, and postpartum depression. Sleep disturbances can also cause depression and stress that affects the fetus. Mild stress causes an increase in fetal heart rate which, if left untreated, will make the baby hyperactive. Meanwhile, the consequences are depression and babies who are born have less time to sleep deeply. Efforts to overcome this sleep disorder are yoga and lavender aromatherapy inhalation. Purpose: Therefore, the researchers estimated that the application of a combination of prenatal gentle yoga and lavender aromatherapy would be more effective in affecting the quality of sleep in pregnant women, so it is hoped that it can reduce sleep disturbances in third trimester pregnant women. Results: There is a significant effect of the combination of prenatal gentle yoga and inhalation of lavender aromatherapy in improving sleep quality in the treatment group with a value of α = 0.011 or α <0.05. There was a significant difference in the quality of sleep in the group compared to the control group with a value of α = 0.004 or α <0.05. Conclusion: By practicing prenatal gentle yoga and regular inhalation of lavender aromatherapy, it will be able to improve sleep patterns without using sleeping pills which wil

scholarly journals Efficacy of balloon tamponade in control of primary postpartum haemorrhage (PPH).

2020 ◽  
Vol 27 (04) ◽  
pp. 717-720
Author(s):  
Kashfa Tasnim Akhtar ◽  
Sobia Tabassum ◽  
Shazia Siddique
Keyword(s):  
Blood Loss ◽  
Gestational Age ◽  
Postpartum Haemorrhage ◽  
Ease Of Use ◽  
P Value ◽  
Balloon Tamponade ◽  
Products Of Conception ◽  
Estimated Blood Loss ◽  
Increased Risk ◽  
Significant Difference

Objectives: Primary postpartum haemorrhage (PPH) refers to excessive blood loss (>500ml) during 3rd stage of labour in the 1st 24 hours after delivery, thereafter, significant bleeding is referred to as secondary PPH. Its incidence is about 5% of deliveries. This study was conducted to note the efficacy of balloon tamponade in the control of PPH. Study Design: Experimental study. Setting: Department of Obstetrics and Gyne, Civil Hospital, Bahawalpur. Period: 1st January 2018 to 30th June 2018. Material & Methods: A total of 80 cases with Primary PPH after vaginal delivery were considered for this study. Cases with Bleeding disorders, ruptured uterus, retained products of conception, genital tract injuries or on anticoagulant therapy were excluded. All patients received balloon tamponade. Failure of control of bleeding was observed amongst all the patients. Results: Mean age, gestational age and parity were 24.54 years, 37.88 weeks and 3.17 respectively. Mean estimated blood loss was found to be 1125+320 ml, SBP 90.10+20.6 mmHg, DBP 57+7.2 mmHg and pulse 106+9.2 bpm. As far efficacy of balloon tamponade is concerned, it was noted in 71 (88.8%) women. When women were analyzed for maternal age, gestational age and parity status, no significant difference was found (P value > 0.05). Conclusion: Balloon tamponade has good efficacy (88.8%) in controlling PPH. Its ease of use in cases at increased risk of PPH makes it a suitable option.

scholarly journals DESCRIPTION OF PRE AND POST HEMOGLOBIN CONDITIONS OF CAESAREAN SECTION

2021 ◽  
Vol 1 (2) ◽  
pp. 102-106
Author(s):  
Eko Puji Rahayu
Keyword(s):  
Cesarean Section ◽  
Pregnant Women ◽  
Cesarean Delivery ◽  
Secondary Data ◽  
Cesarean Birth ◽  
Increased Risk ◽  
Mother And Child ◽  
History Of ◽  
Experienced Operator ◽  
Child Hospital

Background: Cesarean delivery without any indication of an increase should the procedure be safer but there is still an increased risk for pregnant women who have a cesarean birth, which is bleeding. Research Objective: To find out the description of hemoglobin levels pre and post cesarean delivery at the Mother and Child Hospital Dian Pertiwi Karanganyar Regency.Research Methods: This research is secondary data research taken from medical record installations at Dian Pertiwi Mother and Child Hospital in Karanganyar Regency.Results: Of 82 samples of pregnant women who gave birth by cesarean at the Mother and Child Hospital Dian Pertiwi Karanganyar 44 (60%) with normal hemoglobin levels above 12 gr / dl pre-cesarean section and 38 (40%) with hemoglobin levels 11 gr / dl post cesarean section.Conclusion: Samples of pregnant women who gave birth by cesarean and there was no history of anemia before cesarean section, after cesarean section decreased hemoglobin levels 2.1 gr / dl. The decrease in hemoglobin level is also supported by the management carried out by a very experienced operator, according to the procedure that makes a decrease in hemoglobin levels is not much.

scholarly journals A Retrospective Observational Study to Assess Prescription Pattern in Patients with Type B Aortic Dissection and Treatment Outcome

2016 ◽  
Vol 2016 ◽  
pp. 1-10
Author(s):  
Kuang-Ming Liao ◽  
Chung-Yu Chen ◽  
Shih-Han Wang ◽  
Jiann-Woei Huang ◽  
Chen-Chun Kuo ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Primary Outcome ◽  
Proportional Hazards Model ◽  
Medical Center ◽  
Treatment Strategies ◽  
Cox Proportional Hazards Model ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Increased Risk ◽  
Significant Difference

Aortic dissection is a life-threatening condition. However, the use of medication to treat it remains unclear in our population, particularly in patients with a type B aortic dissection (TBAD) who do not receive surgery. This retrospective cohort study evaluated antihypertensive prescription patterns and outcomes in patients with nonsurgical TBAD. We reviewed the hospital records of patients with TBAD at a medical center in Taiwan from January 2008 to June 2013 to assess the baseline information, prescribing pattern, event rate, and clinical effectiveness of different antihypertensive treatment strategies. A Cox proportional hazards model was used to estimate outcomes in different antihypertensive strategies. The primary endpoints were all-cause mortality and hospital admission for an aortic dissection. We included 106 patients with a mean follow-up period of 2.75 years. The most common comorbidity was hypertension followed by dyslipidemia and diabetes mellitus. Study endpoints mostly occurred within 6 months after the index date. Over 80% of patients received dual or triple antihypertensive strategies. Patients treated with different treatment strategies did not have a significantly increased risk of a primary outcome compared with those treated with a monotherapy. We found no significant difference in the primary outcome following the use of different antihypertensive medication regimes.

scholarly journals Why do pregnant women prefer cesarean birth? : a qualitative study in a tertiary care center in Southern Thailand

2020 ◽  
Author(s):  
Chitkasaem Suwanrath ◽  
Sopen Chunuan ◽  
Phawat Matemanosak ◽  
Sutham Pinjaroen
Keyword(s):  
Qualitative Study ◽  
Pregnant Women ◽  
Care Center ◽  
Tertiary Care ◽  
Cesarean Birth ◽  
Superstitious Belief ◽  
Cesarean Births ◽  
Previous Birth ◽  
Southern Thailand ◽  
Medical Indications

Abstract Background: The increasing worldwide rate of cesarean sections is of global concern. In recent years, cesarean births upon maternal request have become both a hotly debated issue. Hence, this study aimed to explore maternal reasons for cesarean preference without medical indications.Methods: A descriptive qualitative study was conducted, using in-depth interviews with 27 pregnant women, attending antenatal care in Songklanagarind Hospital from September 2018 to June 2019, who preferred cesarean birth. Data were analyzed using content analysis.Results: Maternal reasons for cesarean preference were classified into six main categories including: fear of childbirth, safety concerns related to health risk perception, negative previous birth experience, positive attitude toward cesarean birth, access to biased information and superstitious belief in auspicious birth dates. Most women had more than one reason for opting cesarean birth. Conclusion: Several reasons for cesarean birth preference have been elucidated. One striking reason was a superstitious belief in auspicious birth dates, which is challengable for obstetricians to deal with. Obstetricians should explore the exact reasons why women request cesarean birth, so as to prevent or diminish unnecessary cesarean births.

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