scholarly journals P339 Pregnant women with perianal Crohn’s Disease: suggestions for the improvement of the current guideline on delivery method

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S364-S364
Author(s):  
I Schaafsma ◽  
F Hoogenboom ◽  
M Visschedijk ◽  
J Prins ◽  
G Dijkstra
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Vaginal Delivery ◽  
Faecal Incontinence ◽  
Perianal Disease ◽  
Current Guideline ◽  
Dutch Population ◽  
Delivery Method ◽  
General Dutch Population ◽  
Faecal Continence

Abstract Background Pregnant women with active perianal Crohn’s disease (CD), have an indication for a caesarean section according to the current ECCO guidelines. This advice is based on the assumption that vaginal delivery leads to exacerbation of perianal disease and to worsening of faecal continence. However, there is no strong evidence to support this. This study aims to examine the effects of delivery method on perianal disease progression and faecal incontinence in women with perianal CD Methods In this retrospective cohort study, 209 women were selected from a large IBD database within a tertiary hospital in the Netherlands. All women are aged >18 years, have perianal CD, and have at least one child. In addition, 102 women of this cohort completed a questionnaire. Faecal continence was scored using the Vaizey-score. Descriptive analysis using SPSS and linear regression analysis were performed. The outcome was corrected for the years after delivery (median 15, range 0-55). p-values <0,05 were considered statistically significant. Results The caesarean section rate within this cohort was 27,8%, which is high when compared the general Dutch population (14%). Within the group of women who delivered at least one child vaginally (n=84), 25,5% reported an alteration of faecal continence, compared to 18,8% of the women who never had a vaginal delivery (n=18). No significant relation between mode of delivery and faecal continence was found (B 0,97 [-1,19-3,14] p 0,375). The average Vaizey-score within this cohort in women who delivered solely through caesarean section had a median Vaizey-score of 5 (range 0-12). Women who had at least one vaginal delivery had an median Vaizey-score of 7 (range 0-20). In a large study amongst the general Dutch population (n=1259) a median Vaizey-score of 11 (range 0-17) was reported. Conclusion Faecal incontinence after vaginal delivery in CD women with perianal fistula is not significantly increased. Therefore the current guideline to advice a caesarean section should be adjusted and other factors such as the location of the fistula should be taken into account. To draw solid conclusions, better registration of fistula location and objective documentation of fistula activity (using PDAI-score) and stool consistency is needed.

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

scholarly journals Indicators for mode of delivery in pregnant women with uteruses scarred by prior caesarean section: a retrospective study of 679 pregnant women

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Zhifen Hua ◽  
Fadwa El Oualja
Keyword(s):  
Retrospective Study ◽  
Caesarean Section ◽  
Pregnant Women ◽  
Vaginal Delivery ◽  
Gestational Age ◽  
Placenta Previa ◽  
Mode Of Delivery ◽  
Fetal Membrane ◽  
Delivery Mode ◽  
Maternal Preference

Abstract Background The delivery mode for pregnant women with uteruses scarred by prior caesarean section (CS) is a controversial issue, even though the CS rate has risen in the past 20 years. We performed this retrospective study to identify the factors associated with preference for CS or vaginal birth after CS (VBAC). Methods Pregnant women (n = 679) with scarred uteruses from Moulay Ali Cherif Provincial Hospital, Rashidiya, Morocco, were enrolled. Gestational age, comorbidity, fetal position, gravidity and parity, abnormal amniotic fluid, macrosomia, placenta previa or abruptio, abnormal fetal presentation, premature rupture of fetal membrane with labor failure, poor progression in delivery, and fetal outcomes were recorded. Results Out of 679 pregnant women ≥28 gestational weeks, 351 (51.69%) had a preference for CS. Pregnant women showed preference for CS if they were older (95% CI 1.010–1.097), had higher gestational age (95% CI 1.024–1.286), and a shorter period had passed since the last CS (95% CI 0.842–0.992). Prior gravidity (95% CI 0.638–1.166), parity (95% CI 0.453–1.235), vaginal delivery history (95% CI 0.717–1.818), and birth weight (95% CI 1.000–1.001) did not influence CS preference. In comparison with fetal preference, maternal preference was the prior indicator for CS. Correlation analysis showed that pregnant women with longer intervals since the last CS and history of gravidity, parity, and vaginal delivery showed good progress in the first and second stages of vaginal delivery. Conclusions We concluded that maternal and gestational age and interval since the last CS promoted CS preference among pregnant women with scarred uteruses.

scholarly journals Vaginal birth after caesarean section: why and how?

2017 ◽  
Vol 6 (12) ◽  
pp. 5554
Author(s):  
Vidyadhar B. Bangal ◽  
Satyajit Gavhane ◽  
Vishesha Yadav ◽  
Kunal Aher ◽  
Dhruval Bhavsar
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Vaginal Delivery ◽  
Caesarean Section Rate ◽  
Mode Of Delivery ◽  
Vaginal Birth ◽  
Maternal Complications ◽  
History Of ◽  
Spontaneous Onset ◽  
Vaginal Birth After Caesarean

Background: With the significant rise in the incidence of primary caesarean section(CS) for various indications, an increasing proportion of the pregnant women coming for antenatal care, report with a history of a previous CS. This necessitates definite need to bring down the caesarean section rate, either by judicious selection of cases for primary caesarean section or by attempting vaginal delivery, following previous caesarean section (VBAC).Methods: A prospective observational study was conducted to find out the success of VBAC and the common predictive factors leading to successful VBAC. A total of 136 pregnant women with full term pregnancy, having history of previous one lower segment caesarean section and without any other medical and obstetrical complication were enrolled in the study.Results: Majority of the women (95.59%) had spontaneous onset of labor. The success of VBAC was 75 percent. The commonest maternal complications were fever (7.35%), scar dehiscence (3.68%), PPH (1.47%) and wound infection (2.21%).There was significantly higher number of women who had history of previous successful VBAC, had vaginal delivery (91.67%; p=0.038).It was observed that the rate of vaginal delivery was significantly high in women with Bishop’s score between 10 to 13 (94.64%) compared to 6 to 9 (61.25%) (p<0.001).The baby weight determined by ultrasound scan was significantly associated with mode of delivery (p=0.049).Conclusions: Vaginal Birth After Caesarean section is relatively safe, provided it is conducted in carefully selected cases, under constant supervision. Spontaneous onset of labour, good Bishops score and average baby weight were good predictors of successful VBAC.

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 Effect of an Interactive Training on Choosing Delivery Method among Primiparous Pregnant Women: An Interventional Study

2020 ◽  
Vol 38 (1) ◽  
Author(s):  
Nahid Zarifsanaiey ◽  
Alireza Bagheri ◽  
Faezeh Jahanpour ◽  
Samaneh Nematollahi ◽  
Parviz Azodi
Keyword(s):  
Pregnant Women ◽  
Vaginal Delivery ◽  
Delivery Method ◽  
Interventional Study ◽  
Post Intervention ◽  
Delivery Methods ◽  
Interactive Training ◽  
Significant Difference ◽  
Before And After ◽  
Quasi Experimental

Objective. To evaluate the effect of interactive training conducted during pregnancy on choosing delivery method among primiparous women. Methods. Quasi-experimental study carried out in 2017 in two hospitals in the city of Bushehr (Iran), with the participation of 108 primiparous pregnant women in an educational program consisting of eight 2-hour sessions every two weeks in which interactive training activities were performed (group discussions, classroom sessions, and delivery of printed educational material) on themes related with physiological delivery, painless vaginal delivery methods, and complications of cesarean delivery without indication, among others. Before and after the intervention, the Knowledge and Preferred Method of Delivery Questionnaire by Moradabadi et al., was used to obtain information. Results. The results indicated that the level of knowledge in the group of mothers increased significantly between the pre-intervention and post-intervention assessment (13.2 versus 19.4, of 20 possible maximum points; p <0.001). Additionally, significant difference was observed in the selection of the vaginal delivery method before and after the intervention (74.1% versus 98.1%; p<0.001). Conclusion. Implementation of interactive training increased knowledge of pregnant women on the delivery and induced a positive effect to encourage the primiparous mothers to have a vaginal delivery.How to cite this article: Zarifsanaiey N, Bagheri A, Jahanpour F, Nematollahi S, Azodi P. Effect of an Interactive Training on Choosing Delivery Method among Primiparous Pregnant Women: An Interventional Study. Invest. Educ. Enferm. 2020; 38(1):e04.

scholarly journals VAGINAL BIRTH AFTER CAESAREAN SECTION

2010 ◽  
Vol 17 (04) ◽  
pp. 665-669
Author(s):  
SUNBAL KASHIF ◽  
MALAHAT MANSOOR ◽  
RUBINA TARIQ ◽  
Tayyaba Tahira
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Vaginal Delivery ◽  
Lower Abdominal Pain ◽  
Cardiac Activity ◽  
Fetal Distress ◽  
Vaginal Birth ◽  
Bishop Score ◽  
Cross Sectional ◽  
Vaginal Birth After Caesarean

Introduction: Vaginal birth after caesarean section is currently the preferred method of delivery for pregnant women who had previous one lower segment caesarean section. This common practice warrants some reconsideration in light of recent clinical data on the risks associated with VBAC. Objectives: To evaluate conditions which can achieve successful vaginal birth after one caesarean section. Study Design: Cross-sectional analytic study. Setting: Department of Obstetrics and Gynaecology, Unit-I, Services Hospital, Lahore. Duration of Study with Dates: Study was carried out over a period of six months from 08-06-2006 to 07-12-2006. Subjects and Methods: One hundred pregnant women meeting inclusion criteria were included. During trial of labour patients were closely monitored by vital signs, fetal cardiac activity, lower abdominal pain and tenderness, fetal distress, vaginal bleeding and loss of presenting part. Results: Mean age of the patients was 34.27 + 6.45. According to distribution of cases by parity, maximum number i.e 64 (64.0%) was P 3-6. 79 patients (79.0%) had prior vaginal delivery. Maximum 41.0% patients were due to fetal distress while in 28% indication for previous caesarean were breech presentation. In 71% patient membranes were intact while 29.0% patients presented with per vaginal leaking. 51.0% had dilatation between 3-4cm. VBAC was more successful in patients 58.0% with favourable Bishop score. Conclusions: BMI <20, prior vaginal delivery, non-recurrent indication for previous caesarean, spontaneous onset of labour, cervical dilatation or favourable Bishop score, weight of baby < 3.5kg predict an individual’s likelihood of successful VBAC.

scholarly journals Preferences of pregnant women regarding mode of delivery: a questionnaire based study

2017 ◽  
Vol 3 (11) ◽  
pp. 292 ◽  
Author(s):  
Poojan Dogra ◽  
Reena Sharma
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Vaginal Delivery ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Antenatal Clinic ◽  
Tertiary Care Centre ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Knowledge And Attitude

<p><strong>Background: </strong>The rising rate of caesarean section is the subject of concern worldwide. The aim of our study was to know the knowledge, attitude and preferences of pregnant women towards the mode of delivery in a tertiary care centre and hence to see weather this is a contributing factor towards rinsing trend of caesarean delivery or not.  </p><p><strong>Methods: </strong>This was a prospective questionnaire study conducted on 100 antenatal women in third trimester who attended the antenatal clinic in SLBS GMC Mandi at Nerchowk from 1<sup>st</sup> June, 2017 to 1<sup>st</sup> September 2017.The information regarding socio-demographic profile, obstetric history, knowledge and attitude statements towards vaginal delivery and caesarean section was collected and analysed.</p><p><strong>Results: </strong>Total of 100 women was interviewed in our study. Out of these, majority (85%) had received education up to High school and above. Majority of the women (90%) had the positive attitude towards vaginal delivery. The most frequently mentioned source of information about the mode of delivery was relatives and friends. Almost half of women agreed to the statement that vaginal delivery creates a more affectionate mother and baby relationship.  Majority of women co-relate that caesarean section was associated with more complications and not good in long term outcome. Economic factors did not play an important role in deciding caesarean birth.</p><p><strong>Conclusions: </strong>Majority of pregnant women interviewed were interested to deliver vaginally, while some women were indecisive due to lack of knowledge and some due to apprehension of labor pains during vaginal delivery wanted to undergo a caesarean section. Appropriate counselling of pregnant women and their partners will help in changing their outlook and make them a better judge while choosing their preferences.</p>

scholarly journals PERBANDINGAN PERSALINAN SEKSIO SESAREA DAN PERVAGINAM PADA WANITA HAMIL DENGAN OBESITAS

e-CliniC ◽  
2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Adelia S. Ekwendi ◽  
Maya E. Mewengkang ◽  
Frank M. M. Wagey
Keyword(s):  
Body Weight ◽  
Caesarean Section ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Vaginal Delivery ◽  
Descriptive Study ◽  
Age Group ◽  
Microsoft Excel ◽  
Cross Sectional ◽  
Vaginal Deliveries

Abstract: Obesity is a problem throughout the world and is commonly found among women in the region of Southeast Asia. Obesity in pregnant women increases the risk of complications associated with an increasing incidence of caesarean section and a decreasing incidence of vaginal delivery. This study aimed to determine the comparison of caesarean section and vaginal delivery in pregnant women with obesity. This was a descriptive study with a cross-sectional approach. This study used data of the patients’ medical record. Samples were all pregnant women with obesity (BMI ≥30 kg/m2) at the end of pregnancy who underwent caesarean sections and vaginal deliveries in Prof. Dr. R. D. Kandou Hospital Manado from January 2014 until October 2015. The data were processed by using the Microsoft Excel. The results showed that the number of pregnant women with obesity was 926 and of pregnant women who underwent caesarean section was 50.22%. Pregnant women with obesity in the age group over 30 years, nutritional status obese II and III, and body weight over 85 kg were more frequent in undergoing the cesarean section. Conclusion: The higher BMI, body weight, and age of a pregnant woman, the higher risk of undergoing cesarean section compared to vaginal delivery. Keywords: BMI, obesity, caesarean section, vaginal delivery   Abstrak: Obesitas merupakan masalah yang mendunia dan paling banyak dialami oleh wanita di wilayah Asia-Tenggara. Obesitas pada wanita hamil meningkatkan risiko terjadinya komplikasi yang berhubungan dengan peningkatan angka kejadian persalinan seksio sesarea dan penurunan kejadian persalinan pervaginam. Penelitian ini bertujuan untuk mengetahui perbandingan persalinan seksio sesarea dan pervaginam pada wanita hamil dengan obesitas. Penelitian ini menggunakan metode deskriptif dengan pendekatan potong lintang. Penelitian dilakukan dengan melihat catatan rekam medis pasien. Sampel penelitian ialah seluruh wanita hamil dengan obesitas (IMT ≥ 30 kg/m2) pada akhir kehamilan yang menjalani persalinan seksio sesarea dan pervaginam di RSUP Prof. Dr. R. D. Kandou Manado dari bulan Januari 2014 sampai Oktober 2015. Data yang diperoleh diolah dengan menggunakan Microsoft excel. Hasil penelitian menunjukkan bahwa jumlah wanita hamil dengan obesitas 926 orang dan yang menjalani seksio sesarea sebanyak 50,22%. Wanita hamil dengan obesitas pada kelompok umur di atas 30 tahun, status gizi obes II dan III, serta kelompok berat badan lebih dari 85 kg lebih banyak menjalani persalinan seksio sesarea. Simpulan: Semakin meningkat IMT, berat badan, dan usia seorang wanita hamil, maka semakin tinggi risiko menjalani persalinan seksio sesarea dibandingkan pervaginam. Kata kunci: IMT, obesitas, seksio sesarea, persalinan pervaginam

scholarly journals Strategies to reduce the caesarean section rate in a private hospital and their impact

2021 ◽  
Vol 10 (3) ◽  
pp. e001215
Author(s):  
Romulo Negrini ◽  
Izabella Mikaella Souza Campos D’Albuquerque ◽  
Rita de Cássia Sanchez e Oliveira ◽  
Raquel Domingues da Silva Ferreira ◽  
Luciana Francine Bocchi De Stefani ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Vaginal Delivery ◽  
Neonatal Intensive Care ◽  
Caesarean Section Rate ◽  
Albert Einstein ◽  
Second Phase ◽  
Study Population ◽  
Two Phases ◽  
The Impact

There is a concern around the world of an increasing caesarean section rate. It was estimated that between 2010 and 2015, caesarean section rates increased by almost 50%. There are several implications for this, considering that caesarean sections are associated with higher costs and worse clinical outcomes. In this context, several interventions have been considered to increase vaginal delivery rates, including the Adequate Childbirth Project (PPA) in Brazil. This study aimed to verify the impact of the strategies adopted internally in the Hospital Israelita Albert Einstein (HIAE) located in São Paulo, Brazil, regarding the reduction of caesarean sections and their perinatal results. Actions to support our study were implemented in two phases based on the PPA schedule. These actions involved three axes: a multidisciplinary team, pregnant women and facility improvements. All pregnant women admitted for childbirth at the HIAE between 2014 and 2019 were included in this study. The overall rate of vaginal delivery in this study population and among primiparous women and the percentage of admissions to the neonatal intensive care unit (NICU) were analysed in three periods: before the implementation of PPA actions (period A), after the first phase of the project (period B) and after its second phase (period C). The results showed an increase in the average vaginal delivery rate from 23.57% in period A to 27.88% in period B, and to 30.06% in period C (AxB, p<0.001; BxC, p=0.004). There was a decrease in the average of NICU admissions over the periods (period A 19.22%, period B 18.71% and period C 13.22%); a significant reduction was observed when periods B and C (p<0.001) were compared.

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