scholarly journals Uterine Rupture - Risk Factors and Pregnancy Outcome in Bundelkhand Region

2021 ◽  
Vol 10 (27) ◽  
pp. 1961-1965
Author(s):  
Sheela Jain
Keyword(s):  
Risk Factors ◽  
Uterine Rupture ◽  
Fetal Mortality ◽  
Mortality And Morbidity ◽  
Factors Associated ◽  
Uterine Surgery ◽  
Grand Multiparity ◽  
Uterine Scar ◽  
Congenital Uterine Anomaly ◽  
Inter Pregnancy Interval

BACKGROUND Uterine rupture is defined as the tearing of the muscular wall of the uterus during pregnancy or labour.1 Often it occurs from the tearing of previous caesarean scar during labour.2 The other known risk factors for uterine rupture include, maternal age, height, body mass index (BMI), education, birth weight, gestational age, induction of labour, instrumental vaginal delivery, interpregnancy interval, congenital uterine anomaly, grand multiparity, previous uterine surgery, fetal macrosomia, fetal malposition, obstructed labour, uterine instrumentation, attempted forceps delivery, external version, and uterine trauma. 2-6This study was done to find out the prevailing risk factors associated with this grave condition in Bundelkhand region, so that mortality and morbidity associated with it could be prevented. METHODS We have studied 37 cases of uterine rupture, operated in our institution from Jan. 2018 to Oct. 2019. During this period a total of 2986 Caesarean sections (CS) were performed. Of these 37 cases, 5 were Nullipara (13.51 %), 16 primipara (31.25 %) and 16 were grand multipara (31.25 %). 24 cases (64.86 %) had previous uterine scar while 13 (35.13 %) had no scar. RESULTS In our study major risk factors for uterine rupture were found to be previous scars (64.68 %). Obstructive labour (23.07 %), malpresentation (7.69 %), grand multiparity (38.46 %) and prolong labour (30.76 %), were responsible for rupture in unscarred uterus. In all cases we first tried to repair the tear and only 9 (24.32 %) needed hysterectomy. In our study 28 patients (75.67 %) required only repair whereas 24.32 % cases needed hysterectomy. Maternal death was just 1 case (2.7 %) and (51.35 %) babies survived. CONCLUSIONS Majority of uterine rupture cases were found in women who had previous CS. So, first CS should be performed after very careful understanding of its indications. 2.7 % maternal mortality and 51.35 % delivery of live birth babies in our study proves that early detection and proper managing of the case can reduce maternal and fetal mortality in uterine rupture cases. KEY WORDS Uterine Rupture, Previous Scar, Inter-Pregnancy Interval

scholarly journals Uterine Rupture with Evisceration of Intestines through the Vagina during Labour

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Ubong Akpan ◽  
Chinyere Akpanika ◽  
Victor Nwagbara ◽  
Udeme Asibong ◽  
Saturday Etuk
Keyword(s):  
Risk Factors ◽  
Perinatal Mortality ◽  
Uterine Rupture ◽  
Factors Associated ◽  
Obstetric Emergency ◽  
Modes Of Presentation ◽  
Grand Multiparity ◽  
Life Threatening ◽  
Small Intestines ◽  
Scarred Uterus

Uterine rupture is a life threatening obstetric emergency and is associated with high maternal and perinatal mortality. There are some risk factors associated with uterine rupture which may include: prolonged obstructed labour, previous scarred uterus, grand-multiparity, macrosomic baby, abnormal lie, instrumental delivery, induction of labour, oxytocin stimulation and excessive uterine manipulation. Its modes of presentation have been widely reported. Here, we present a case with an unusual mode of presentation where about two-third of the small intestines protruded through the vagina following some manipulations by an unskilled birth attendant. This highlights the fact that when uterine rupture is suspected, the cord-like structure protruding per vaginum may not always be umbilical cord.

scholarly journals A Systematic Review of Risk Factors Associated with Near-Fatal and Fatal Asthma

2005 ◽  
Vol 12 (5) ◽  
pp. 265-270 ◽  
Author(s):  
GG Alvarez ◽  
M Schulzer ◽  
D Jung ◽  
JM FitzGerald
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Inhaled Corticosteroids ◽  
Respiratory Arrest ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Mortality And Morbidity ◽  
Factors Associated ◽  
Fatal Asthma ◽  
The Impact

BACKGROUND: Asthma mortality and morbidity continue to be a serious global problem. Systematic reviews provide an opportunity to review risk factors in detail.OBJECTIVE: To review all of the literature for risk factors associated with near-fatal asthma (NFA) and fatal asthma (FA).METHODS: A literature search from 1960 to January 2004 in MEDLINE and EMBASE was conducted. Studies were included based on the following criteria: NFA was defined as an asthma exacerbation resulting in respiratory arrest requiring mechanical ventilation or a partial pressure of CO2of at least 45 mmHg or asthma resulting in death (FA); the study reported the number of cases (NFA and/or FA) and asthmatic controls; there was explicit reporting of risk factors; cases that were adult and pediatric in nature; and all study types. Studies that included patients with chronic obstructive pulmonary disease were excluded.RESULTS: Four hundred and three articles were identified, of which 27 met the inclusion criteria. Increased use of medications such as beta-agonists via metered dose inhalers (OR=1.67, 95% CI 0.99 to 2.84, P=0.057) and nebulizers (OR=2.45, 95% CI 1.52 to 3.93, P=0.0002), oral steroids (OR=2.71, 95% CI 1.34 to 5.51, P=0.006) and oral theophylline (OR=2.02, 95% CI 1.03 to 3.98, P=0.04) and a history of hospital (OR=2.62, 95% CI 1.04 to 6.58, P=0.04) and/or intensive care unit (OR=5.14, 95% CI 1.91 to 13.86, P=0.001) admissions and mechanical ventilation (OR=6.69, 95% CI 2.80 to 15.97, P=0.0001) due to asthma were predictors of NFA and FA. Prior emergency department assessment did not confer a greater risk of NFA and FA (OR=1.13, 95% CI 0.43 to 2.92, P=0.810).The use of inhaled corticosteroids (ICS) measured in a dose-independent fashion (did the patient take ICS previously; yes or no) inferred equivocal risk of NFA and FA (OR=1.31, 95% CI 0.83 to 2.05, P=0.25). However, two studies measured the use of ICS in a dose-dependent fashion (ie, measured the number of prescriptions filled within the previous six to 12 months). Both studies showed a trend toward a protective effect against FA. One study showed that the premature cessation of ICS can hasten death.CONCLUSIONS: In the present study, risk factors of NFA and FA have been more accurately defined. Clinicians should identify patients with these characteristics to reduce their risk of NFA and FA. Further research should focus on quantifying the impact of risk factors on asthma deaths.

scholarly journals Determinants of low birth weight deliveries at five referral hospitals in Western Area Urban district, Sierra Leone

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
David Kabba Kargbo ◽  
Kofi Nyarko ◽  
Samuel Sackey ◽  
Adolphina Addo-Lartey ◽  
Ernest Kenu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Sierra Leone ◽  
Health Care Providers ◽  
Care Providers ◽  
Urban District ◽  
Factors Associated ◽  
Western Area ◽  
Inter Pregnancy Interval

Abstract Background Low birth weight (LBW) contributes significantly to infant and child mortality. Each year, about 20 1million deliveries are LBW with 96.5% occurring in developing countries. Whiles the incidence of LBW is reducing in other districts of Sierra Leone, it has been reported to be increasing in the Western Area Urban district. Determining the risk factors in a specific geographic area is important for identifying mothers at risk and thereby for planning and taking appropriate action. The current study sought to identify factors associated with LBW deliveries in the Western Area Urban district of Sierra Leone. Methods A hospital-based unmatched 1:2 case-control study was conducted among mothers who delivered live singleton babies from November, 2019 to February, 2020 in five referral health facilities. Mothers were conveniently sampled and sequentially enrolled into the study after delivery. Their antenatal care cards were reviewed and a pre-tested questionnaire administered to the mothers. Data analysis was done using Stata 15.0 and association between maternal socio-demographic, socio-economic, obstetric and lifestyle factors and LBW assessed using bivariable and multivariable logistic regression analyses. Results A total of 438 mothers (146 cases and 292 controls), mean age: 24.2 (±5.8) and 26.1 (±5.5) years for cases and controls respectively participated in the study. Multivariable analysis revealed that being unemployed (AoR = 2.52, 95% CI 1.16–5.49, p = 0.020), having anaemia during pregnancy (AoR = 3.88, 95% CI 1.90–7.90, p <  0.001), having less than 2 years inter-pregnancy interval (AoR = 2.53, 95% CI 1.11–5.73, p = 0.026), and smoking cigarettes during pregnancy (AoR = 4.36, 95% CI 1.94–9.80, p <  0.001) were significantly associated with having LBW babies. Conclusion Factors associated with LBW identified were unemployment, anaemia during pregnancy, < 2 years inter-pregnancy interval and cigarette smoking during pregnancy. Health care providers should screen and sensitize mothers on the risk factors of LBW during antenatal sessions.

scholarly journals Symptomatic Uterine Rupture: A Fifteen Year Review

Medicina ◽  
2020 ◽  
Vol 56 (11) ◽  
pp. 574
Author(s):  
Egle Savukyne ◽  
Raimonda Bykovaite-Stankeviciene ◽  
Egle Machtejeviene ◽  
Ruta Nadisauskiene ◽  
Regina Maciuleviciene
Keyword(s):  
Risk Factors ◽  
Abdominal Pain ◽  
Incidence Rate ◽  
Cesarean Delivery ◽  
Epidural Anaesthesia ◽  
Uterine Rupture ◽  
Acute Abdominal Pain ◽  
Significant Risk ◽  
Uterine Scar ◽  
Previous Cesarean

Background and objectives: To assess the incidence of complete and partial uterine rupture during childbirth in a single tertiary referral centre as well as the significant risk factors, symptoms and peripartum complications. Materials and Methods: A retrospective single-centre study involved all cases of uterine rupture at the Kaunas Perinatal Centre in 2004–2019. Data were from a local medical database complemented with written information from medical records. We included 45,893 women with an intact uterus and 5630 with uterine scars. Women (n = 5626) with scarred uterus’ after previous cesarean delivery. The diagnosis was defined by clinical symptoms, leading to an emergency cesarean delivery, when complete or partial uterine rupture (n = 35) was confirmed. Asymptomatic cases, when uterine rupture was found at elective cesarean section (n = 3), were excluded. The control group is represented by all births delivered in our department during the study period (n = 51,525). The outcome was complete (tearing of all uterine wall layers, including serosa and membranes) and partial uterine rupture (uterine muscle defect but intact serosa), common uterine rupture symptoms. Risk factors were parameters related to pregnancy and labour. Results: 51,525 deliveries occurred in Kaunas Perinatal Centre during the 15 years of the study period. A total number of 35 (0.06%) symptomatic uterine ruptures were recorded: 22 complete and 13 partial, leading to an incidence rate of 6.8 per 10,000 deliveries. The uterine rupture incidence rate after a single previous cesarean delivery is 44.4 per 10,000 births. 29 (83%) cases had a uterine scar after previous cesarean, 4 (11%) had a previous laparoscopic myomectomy, 2 (6%) had an unscarred uterus. The most significant risk factors of uterine rupture include uterine scarring and augmentation or epidural anaesthesia in patients with a uterine scar after cesarean delivery. The most common clinical sign was acute abdominal pain in labour 18 (51%). No maternal, six intrapartum perinatal deaths (17%) occurred, and one hysterectomy (2.8%) was performed due to uterine rupture. Neonatal mortality reached 22% among the complete ruptures. Average blood loss was 1415 mL, 4 (11%) patients required blood transfusion. Conclusions: The incidence rate of uterine rupture (complete and incomplete) at Kaunas Perinatal Centre is 6.8 per 10,000 deliveries. In cases with a scar of the uterus after a single cesarean, the incidence of uterine rupture is higher, exceeding 44 cases per 10,000 births. The most significant risk factors were uterine scar and augmentation or epidural anaesthesia in a previous cesarean delivery. Acute abdominal pain in labour is the most frequent symptom for uterine rupture.

Risk Factors for the Development of Nosocomial Pneumonia and Its Clinical Impact in Cardiac Surgery

2021 ◽  
Author(s):  
Ferdinand Jr Rivera Gerod ◽  
Edgar Ongjoco ◽  
Rod Castro ◽  
Armin Masbang ◽  
Elmer Casley Repotente ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Hospital Mortality ◽  
Nosocomial Pneumonia ◽  
Clinical Impact ◽  
Adult Patients ◽  
Mortality And Morbidity ◽  
Factors Associated ◽  
Prolonged Icu Stay

Abstract BackgroundThe development of nosocomial pneumonia after cardiac surgery is a significant post-operative complication that may lead to increased morbidity, mortality, and hospital cost. We aimed to identify risk factors associated with it and to determine its clinical impact in terms of in-hospital mortality and morbidity.MethodsThis is a retrospective cohort study conducted among all adult patients who underwent cardiac surgery from 2014-2019 in St. Luke’s Medical Center, Quezon City, Philippines. Baseline characteristics and possible risk factors for pneumonia were retrieved from medical records. Nosocomial pneumonia was based on the Centers for Disease Control and Prevention criteria. Clinical outcomes include in-hospital mortality and morbidity. Odds ratios from logistic regression was computed to determine risk factors associated with pneumonia using STATA 15.0.ResultsOut of 373 patients included in this study, 104 (28%) patients acquired pneumonia. Most surgeries were coronary artery bypass graft (CABG) (71.58%), followed by valve repair/replacement (29.76%). Neither age, sex, BMI, diabetes, LV dysfunction, renal dysfunction, COPD/asthma, urgency of surgery, surgical time, nor smoking showed association in the development of pneumonia. However, preoperative stay of >2 days was associated with 92.3% (95%CI 18–213%) increased odds of having pneumonia (p=.009). Also, every additional hour on mechanical ventilation conferred 0.8% (95%CI, 0.3–1%) greater odds of acquiring pneumonia (p=.003).Patients who developed pneumonia had 3.9 times odds of mortality (95%CI 1.51–9.89, p=.005), 3.8 times odds of prolonged hospitalization (95%CI 1.81–7.90,p<.001), 6.4 times odds of prolonged ICU stay (95%CI 3.59–11.35,p<.001), and 9.5 times odds of postoperative reintubation (95%CI 3.01–29.76,p<.001). ConclusionAmong adult patients undergoing cardiac surgeries, prolonged preoperative hospital stay and prolonged mechanical ventilation were both associated with an increased risk for nosocomial pneumonia. Those who developed pneumonia had worse outcomes with significantly increased in-hospital mortality, prolonged hospitalization, prolonged ICU stay, and increased postoperative re-intubation. Clinicians should therefore minimize delays in surgery to avoid unnecessary exposure to pathogenic organisms. Also, timely liberation from mechanical ventilation after surgery should be encouraged.

Assessment of risk factors associated with pre-term labour in Tertiary care Hospitals, Lahore

2021 ◽  
Vol 15 (1) ◽  
pp. 13-17
Author(s):  
Tanzeela Zafar ◽  
Iram Manzoor ◽  
Fariha Farooq
Keyword(s):  
Risk Factors ◽  
Preterm Birth ◽  
Cesarean Section ◽  
Preterm Births ◽  
Intrauterine Death ◽  
Singleton Pregnancy ◽  
Factors Associated ◽  
History Of ◽  
Tract Infections ◽  
Inter Pregnancy Interval

Background: Pakistan has one of the highest rates of preterm births, nearly 16 for every 100 babies born. Around 4% of these premature babies, are at highest likelihood of death. The objective of this study was to assess association of multiple risk factors with preterm birth in Pakistani women. Patients and methods:  An analytical cross-sectional study was carried out in Obstetrics and Gynecology Department of Akhtar Saeed Trust Hospital and Farooq Hospital, West Wood Branch, Lahore from October 2018 to December 2019. Total 116 pregnant females who gave birth to preterm babies with gestational age between 20-37 weeks were included. Data about patients’ socio-demographic profile, previous obstetric history and current gestational profile was collected using closed ended structured questionnaire. Variables were presented in the form of frequency tables. Chi-square and Fisher exact test were applied to establish association of various risk factors and preterm presentation of patients’ in hospital. A p-value ≤ 0.05 was taken as significant. Results: Out of 116 participants, 49 (42.2%) were aged between 20-25 years, 47 (40.5%) were illiterate. Of the total sample 60 (51.7 %) participants were obese (BMI >30). Eighty-two (70.7%) patients were multigravida and 65 (56.1%) gave the history of previous cesarean section. Significant association was found between preterm birth and multi-parity (p=0.001), previous history of abortion (p=0.000), intrauterine death (p=0.001), infertility (p=0.04), cesarean-section (p=0.000), and inter-pregnancy interval of less than 24 months (p=0.007). Other significant factors associated with preterm labour were urinary tract infections (p=0.001), documented fever more than 101oF (p=0.000), anemia (p=0.000), singleton pregnancy (p=0.000) and cephalic fetal presentation (p=0.002), during current pregnancy. Conclusion: Multi-gravidity, history of abortion, intrauterine death, previous infertility, cesarean-section, inter-pregnancy interval of less than 24 months, UTI, genital tract infection, anemia, singleton pregnancy and cephalic fetal presentation during current pregnancy were observed to be significantly associated with preterm births.

scholarly journals Risk factors of uterine rupture with a special interest to uterine fundal pressure

2017 ◽  
Vol 45 (3) ◽  
Author(s):  
Karin Sturzenegger ◽  
Leonhard Schäffer ◽  
Roland Zimmermann ◽  
Christian Haslinger
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cesarean Section ◽  
Subgroup Analysis ◽  
Uterine Rupture ◽  
Significant Risk ◽  
Abnormal Placentation ◽  
Singleton Pregnancy ◽  
Uterine Surgery ◽  
Fundal Pressure

AbstractPurpose:Uterine rupture is a rare but serious event with a median incidence of 0.09%. Previous uterine surgery is the most common risk factor. The aim of our study was to analyze retrospectively women with uterine rupture during labor and to evaluate postulated risk factors such as uterine fundal pressure (UFP).Methods:Twenty thousand one hundred and fifty-two deliveries were analyzed retrospectively. Inclusion criteria were 22 weeks and 0 days–42 weeks and 0 days of gestation, singleton pregnancy and cephalic presentation. Women with primary cesarean section were excluded. A logistic regression analysis adjusting for possible risk factors was conducted and a subgroup analysis of women with unscarred uterus was performed.Results:Twenty-eight cases of uterine rupture were identified (incidence: 0.14%). Uterine rupture was noticed in multipara patients only. In the multivariate analysis among all study patients, only previous cesarean section remained a statistically significant risk factor [adjusted odds ration (adj. OR) 12.52 confidence interval (CI) 95% 5.21–30.09]. In the subgroup analysis among women with unscarred uterus (n=19,415) three risk factors were associated with uterine rupture: UFP (adj. OR 5.22 CI 95% 1.07–25.55), abnormal placentation (adj. OR 20.82 CI 95% 2.48–175.16) and age at delivery >40 years (adj. OR 4.77 CI 95% 1.44–15.85).Conclusions:The main risk factor for uterine rupture in the whole study population is previous uterine surgery. Risk factors in women with unscarred uterus were UFP, abnormal placentation, and age at delivery >40 years. The only factor which can be modified is UFP. We suggest that UFP should be used with caution at least in presence of other supposed risk factors.

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.

Letter to Editor: Impact of labor on uterine scar healing

Open Medicine ◽  
2013 ◽  
Vol 8 (4) ◽  
pp. 434-435 ◽  
Author(s):  
Stéphanie Roberge ◽  
Emmanuel Bujold
Keyword(s):  
Risk Factors ◽  
Uterine Rupture ◽  
Complete Healing ◽  
Uterine Scar ◽  
Scar Healing

AbstractUltrasound of uterine scar after cesarean and measurement of its thickness can be used to evaluate its healing and risk factors for scar defect and uterine rupture. However, we believe that a period of up to 6 months after surgery is necessary to achieve complete healing of the scar, especially in cases of cesarean performed during labor.

Sign in / Sign up

Export Citation Format

Share Document