scholarly journals Personal Preference of Mode of Delivery. What do Urogynaecologists choose? Preliminary Results of the DECISION Study

2017 ◽  
Vol 77 (11) ◽  
pp. 1182-1188 ◽  
Author(s):  
Julia Bihler ◽  
Ralf Tunn ◽  
Christl Reisenauer ◽  
Jan Pauluschke-Fröhlich ◽  
Philipp Wagner ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Risk Stratification ◽  
Pelvic Floor ◽  
Vaginal Delivery ◽  
Elective Caesarean Section ◽  
Mode Of Delivery ◽  
Online Questionnaire ◽  
Personal Attitude ◽  
Uncomplicated Pregnancy ◽  
Study Participants

Abstract Introduction Currently, almost every third child in Germany is delivered by caesarean section. Apart from straightforward and clear indications for caesarean section which account for approx. 10%, the large proportion of relative indications in particular needs to be critically reviewed if the current C-section rate is to be effectively lowered. It is more than doubtful, however, whether this can be a realistic goal in Germany, especially in the context of international developments. All studies on this topic demonstrate that the personal attitude of the obstetric team has a considerable influence on the pregnant womanʼs personally preferred mode of delivery. Therefore, in the first part of the DECISION study, the personal preferences of urogynaecologists were evaluated regarding the best suitable mode of delivery. Material and Methods All 432 delegates at the 9th German Urogynaecology Congress in Stuttgart in April 2017 were invited to participate in an online questionnaire study. The questionnaire was developed especially for this study. Results Of the 432 registered delegates, 189 (43.8%) participated in the survey. 84.7% (n = 160) of the study participants would prefer a vaginal delivery, in an otherwise uncomplicated pregnancy. Only 12.2% (n = 23) opted for an elective caesarean section. The main reasons stated for this decision were concerns about incontinence (87.5%) and pelvic floor trauma (79.2%). Amongst the study participants, 83.6% would like to be part of a risk stratification system presented in the questionnaire which, with the aid of specific parameters, is intended to allow early identification of a population with a high risk of developing pelvic floor disorders. There was also great interest in postpartum pelvic floor recovery (97.8%) and an associated optional pessary therapy (64.4%). The type of delivery already experienced (vaginal delivery vs. primary caesarean section) and parity also reveals to have a significant influence on the personal preferred mode of delivery as well. Conclusions Urogynaecologists prefer vaginal delivery for themselves. There is a great interest to participate in a risk stratification process in order to approach childbirth in an individualized and risk-adapted manner.

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

scholarly journals Perinatal determinants of D-dimer levels in a cross-sectional study of low risk pregnant women

2016 ◽  
Vol 9 (2) ◽  
pp. 78-82
Author(s):  
NM Murphy ◽  
AS Khashan ◽  
DI Broadhurst ◽  
O Gilligan ◽  
K O’Donoghue ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Vaginal Delivery ◽  
Elective Caesarean Section ◽  
Mode Of Delivery ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
D Dimer ◽  
In Pregnancy

Background To examine perinatal determinants of the antenatal levels of D-dimers. Methods Cross-sectional study of 760 low risk pregnant women recruited into five gestational groups. Variables examined in antenatal groups included maternal age, body mass index, parity, smoking, family history venous thromboembolism (VTE) and previous use of the oral contraceptive pill (OCP). Onset of labour and mode of delivery were also examined in the post-natal group. Results D-dimer levels in group 4 (38–40 + 6) were significantly lower in the women with a history of taking the OCP when compared to those that had not taken it in the past ( P = 0.027). In the day 2 post-natal group, the median level of D-dimer was significantly higher in primparous when compared to multiparous women ( P = 0.015). The median D-dimer levels were significantly lower in the elective Caesarean section group in comparison to spontaneous onset ( P = 0.003) and induction of labour ( P = 0.016). When the mode of delivery was examined, the median D-dimer levels were significantly lower in those that had an elective Caesarean section when compared to normal vaginal delivery ( P = 0.008) and instrumental vaginal delivery ( P = 0.007). Women post elective Caesarean section had a significantly lower D-dimer than those after emergency Caesarean section ( P = 0.008). Discussion There are some significant differences in D-dimer levels when certain perinatal determinants are examined. This work is potentially beneficial to the future diagnosis of VTE in pregnancy as it supports previously published recommended D-dimer levels for the diagnosis of VTE in pregnancy.

scholarly journals Evaluation of Maternal and Fetal Stress Hormones During the Process of Birth

2018 ◽  
Vol 24 (2) ◽  
pp. 65
Author(s):  
Burcu Kisa Karakaya ◽  
Ozlem Moraloglu ◽  
Rahime Bedir Findik ◽  
Necati Hancerliogullari ◽  
Hatice Celik ◽  
...  
Keyword(s):  
Stress Response ◽  
Caesarean Section ◽  
Vaginal Delivery ◽  
Umbilical Cord ◽  
Elective Caesarean Section ◽  
Mode Of Delivery ◽  
Normal Vaginal Delivery ◽  
Singleton Pregnancy ◽  
Beta Endorphin ◽  
Tertiary Center

<p><strong>Objective:</strong> This study aims to determine whether mode of delivery is associated with the endocrine stress response in mother and newborn.</p><p><strong>Study Design:</strong> This prospective observational study was conducted with 86 women with a normal singleton pregnancy who delivered healthy infants between 37 and 41 weeks of gestation in a tertiary center. Study groups included; (1) women undergoing normal vaginal delivery with epidural anesthesia, (2) women undergoing vaginal delivery with immersion in water for pain relief during labor, (3) women delivered through elective caesarean section without labor. After delivery, thyroid stimulating hormone, cortisol, insulin, prolactin and Beta-endorphin levels were measured in maternal and umbilical cord serum and their relationships between modes of delivery were investigated.</p><p><strong>Results:</strong> It was found that the concentrations of cortisol and beta-endorphin after vaginal delivery with immersion in water group in both mothers and infants were higher than other two modes of delivery and these differences were statistically significant. Umbilical cord concentration of cortisol was the lowest in the caesarean section group.</p><p><strong>Conclusions:</strong> Maternal and fetal stress response was found to be associated with the mode of delivery and labor.</p>

scholarly journals First-trimester maternal serum vitamin D and mode of delivery

2012 ◽  
Vol 108 (11) ◽  
pp. 1972-1975 ◽  
Author(s):  
Makrina D. Savvidou ◽  
Mahlatse Makgoba ◽  
Pedro T. Castro ◽  
Ranjit Akolekar ◽  
Kypros H. Nicolaides
Keyword(s):  
Vitamin D ◽  
Caesarean Section ◽  
Vaginal Delivery ◽  
Elective Caesarean Section ◽  
Mode Of Delivery ◽  
First Trimester ◽  
Maternal Serum ◽  
Emergency Caesarean Section ◽  
Maternal Vitamin ◽  
Vitamin D Levels

Low maternal vitamin D levels have been associated with adverse pregnancy outcome. A recent study has suggested that low maternal vitamin D levels at the time of delivery are also associated with an almost fourfold increase in caesarean section risk. The aim of the present study was to investigate whether there is a difference in maternal serum 25-hydroxyvitamin D (25(OH)D) levels at 11–13 weeks' gestation according to the mode of delivery. Maternal serum 25(OH)D levels were measured at 11–13 weeks' gestation in 995 singleton pregnancies resulting in the birth of phenotypically normal neonates at term. The measured 25(OH)D levels were adjusted for maternal age, BMI, racial origin, smoking, method of conception and season of blood testing, and the adjusted levels (multiple of the median; MoM) were compared between those who subsequently delivered vaginally and those that delivered by caesarean section. Delivery was vaginal in 79·6 % of cases, by emergency caesarean section in 11·6 % and by elective caesarean section in 8·8 %. The median 25(OH)D level in our population was 46·82 (interquartile range (IQR) 27·75–70·13) nmol/l. The adjusted maternal median 25(OH)D levels in the emergency and elective caesarean section groups (0·99, IQR 0·71–1·46 MoM and 0·96, IQR 0·73–1·27 MoM, respectively) were not significantly different from the vaginal delivery group (0·99, IQR 0·71–1·33 MoM; P = 0·53 and P = 0·81, respectively). First-trimester maternal serum 25(OH)D levels are similar between women who subsequently have a vaginal delivery and those who deliver by elective or emergency caesarean section.

The evaluation of cord blood interleukin-1β levels in normal and caesarean deliveries

2014 ◽  
Vol 33 (12) ◽  
pp. 1193-1198 ◽  
Author(s):  
A Gedikbaşi ◽  
Ö Salihoğlu ◽  
A Çankaya ◽  
V Arica ◽  
CH Akkuş ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Cord Blood ◽  
Vaginal Delivery ◽  
Elective Caesarean Section ◽  
Mode Of Delivery ◽  
Blood Levels ◽  
Hypoxic Stress ◽  
Foetal Distress ◽  
Normal Delivery ◽  
Term Neonates

Objective: The aim of this prospective study was to establish the cord blood interleukin 1β (IL-1β) levels and asphyxia enzymes in term newborns and their relationship between delivery modes. We investigated whether cord blood level of IL-1β could be used as a reliable marker for detecting hypoxic stress and to determine the optimal cut-off level for IL-1β. Methods: The study was designed prospectively. Cord blood samples were obtained at the time of delivery from 75 noninfected full-term neonates for the purpose of measuring cord blood levels of IL-1β. Women were classified into three groups according to the mode of delivery (20 vaginal delivery, 29 urgent caesarean section (with foetal distress) and 26 elective caesarean section). All cases were followed-up by hospitalization. Umbilical cord sampling was carried out for IL-1β, umbilical artery gas parameters and other asphyxia enzymes at the time of delivery. Cord blood IL-1β was measured by enzyme-linked immunosorbent assay. The perinatal outcomes of the cases were recorded after birth. Demographic characteristics, neonatal outcomes and laboratory findings were compared in all the three groups. Results: IL-1β levels showed statistically significant difference between groups ( p < 0.01). The relationship was found between IL-1β cord blood levels and the mode of delivery. IL-1β levels of urgent caesarean section group were significantly higher than elective caesarean section and normal delivery group ( p:0.001 and p:0.001, respectively). Normal delivery levels were significantly higher than the elective caesarean group ( p:0.001). Conclusion: Urgent section (foetal distress) and vaginal delivery (labour) were each associated with elevated IL-1β cord blood levels in noninfected full-term neonates, while only elective caesarean section was associated with decreased IL-1β levels. For the evaluation of newborns at high risk for perinatal hypoxic stress, cord blood IL-1β levels may lead the way. On the other hand, the mode of delivery may be associated with the effects on the immune system. Further investigations with larger patient groups are required to confirm our results.

scholarly journals Postpartum femoral neuropathy: managing the next pregnancy

2019 ◽  
Vol 12 (12) ◽  
pp. e232967 ◽  
Author(s):  
Cathy Rowland ◽  
Daniel Kane ◽  
Maeve Eogan
Keyword(s):  
Caesarean Section ◽  
Motor Function ◽  
Lower Limb ◽  
Elective Caesarean Section ◽  
Mode Of Delivery ◽  
Primiparous Woman ◽  
Limb Weakness ◽  
Femoral Neuropathy ◽  
Lower Limb Weakness ◽  
Spontaneous Labour

A 34-year-old primiparous woman presented in spontaneous labour and had an unassisted vaginal birth of a 3.5 kg infant. Postnatally, the patient experienced lower limb weakness and was unable to mobilise unassisted. A diagnosis of postpartum femoral neuropathy was made. Full recovery of normal motor function was not achieved until 5 months postpartum. She returned in her next pregnancy, seeking advice on how to avoid this complication from reoccurring. It was decided that an elective caesarean section was an appropriate mode of delivery, which she underwent at 39 weeks without complication and without recurrence of the femoral neuropathy.

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 On demand caesarean section: What’s women’s attitude?

1970 ◽  
Vol 2 (2) ◽  
pp. 12-15
Author(s):  
Nira S Shrestha ◽  
Sumita Pradhan
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Vaginal Delivery ◽  
Caesarean Delivery ◽  
Mode Of Delivery ◽  
University Teaching ◽  
Normal Vaginal Delivery ◽  
On Demand ◽  
Assisted Delivery ◽  
The Right

Objectives: To evaluate the knowledge and attitude of Nepalese women towards mode of delivery and caesarean on demand. Study design: Hospital based cross sectional descriptive study where 200 pregnant women after 37 completed weeks of gestation were recruited randomly and interviewed, and their answers were analyzed. Results: Of the 200 interviewed pregnant women, all of them knew about normal vaginal delivery and caesarean delivery, but only 30% knew about instrumentally assisted delivery and 9% had heard about painless labour. Vaginal delivery was the preferred mode in 93% and 7% preferred caesarean delivery. Only 35% of the interviewed women believed that women should have the right to demand a caesarean section Conclusion: Knowledge assessment of two hundred women regarding the mode of delivery clearly indicates the need for strengthening counseling aspect of antenatal care and awareness program regarding mode of delivery. In Nepal on demand caesarean section is not provided in the University Teaching Hospital. However one third of women still felt that women should have the right to choose caesarean section on demand. Key words: Attitude, mode of delivery, Caesarean on demand. doi:10.3126/njog.v2i2.1448 N. J. Obstet. Gynaecol 2007 Nov-Dec; 2 (2): 12 - 15

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