Primary cesarean section in term, low-risk multiparous women: a single clinic retrospective observational study

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Kimitoshi Imai MD
Keyword(s):  
Observational Study ◽  
Cesarean Section ◽  
Breech Presentation ◽  
Vaginal Birth ◽  
Low Risk ◽  
Retrospective Observational Study ◽  
Vacuum Extraction ◽  
Cesarean Sections ◽  
Vaginal Deliveries ◽  
Multiparous Women

Background: Multiparous women who have previously delivered vaginally are generally considered to be at low risk for cesarean section. We aimed to determine the incidence rate and indications for primary cesarean section and operative vaginal deliveries among multiparous women with previous vaginal births. Patients and methods: Multiparous women who had delivered their babies in our clinic between January 2004 and December 2019 were enrolled in this retrospective observational study. The inclusion criteria were as follows: delivery at 37 weeks of gestation or more, singleton pregnancy with a live fetus, had one or more past vaginal deliveries including instrumental vaginal birth, and no history of previous cesarean section. Women with placenta previa, abruptio placentae, severe pregnancy-induced hypertension, and uncontrolled medical diseases were referred to tertiary hospitals and excluded from this study. The frequency of occurrence and indications for cesarean section and vacuum extraction, duration of labor, and the effect of induction of labor on the cesarean section rates were analyzed. Results: A total of 3094 multiparous women were enrolled. Primary cesarean section was performed in 30 women (30/3094=0.97%). The indications for cesarean section included the following: breech presentation in 28 women, myomectomy after the first vaginal birth in one (of 29 elective cesarean sections), and failed vacuum extraction after a prolonged second stage in one (one emergency cesarean section). Vacuum extraction was performed in 61 women (61/3094=2.0%), the indications for which were non-reassuring fetal status (n=38), prolonged 2nd stage of labor (n=10), and narrow pelvic outlet (n=10). Vaginal breech delivery occurred in 11 women. Induction of labor (n=402) did not affect the cesarean section rate. Conclusion: In multiparous women, breech presentation was the main indication for primary cesarean sections, and the cesarean section rate was very low in women with cephalic presentation.

Vaginal birth after cesarean (VBAC): fear it or dare it? An evaluation of potential risk factors

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Anastasia Lazarou ◽  
Magdalena Oestergaard ◽  
Johanna Netzl ◽  
Jan-Peter Siedentopf ◽  
Wolfgang Henrich
Keyword(s):  
Body Mass Index ◽  
Birth Weight ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Body Mass ◽  
Vaginal Birth ◽  
Vacuum Extraction ◽  
Vaginal Birth After Cesarean ◽  
Vaginal Deliveries ◽  
Spontaneous Delivery

Abstract Objectives The consultation of women aspiring a vaginal birth after caesarean may be improved by integrating the individual evaluation of factors that predict their chance of success. Retrospective analysis of correlating factors for all trials of labor after caesarean that were conducted at the Department of Obstetrics of Charité-Universitätsmedizin Berlin, Campus Virchow Clinic from 2014 to October 2017. Methods Of 2,151 pregnant women with previous caesarean, 408 (19%) attempted a vaginal birth after cesarean. A total of 348 women could be included in the evaluation of factors, 60 pregnant women were excluded because they had obstetric factors (for example preterm birth, intrauterine fetal death) that required a different management. Results Spontaneous delivery occurred in 180 (51.7%) women and 64 (18.4%) had a vacuum extraction. 104 (29.9%) of the women had a repeated caesarean delivery. The three groups showed significant differences in body mass index, the number of prior vaginal deliveries and the child’s birth weight at cesarean section. The indication for the previous cesarean section also represents a significant influencing factor. Other factors such as maternal age, gestational age, sex, birth weight and the head circumference of the child at trial of labor after caesarean showed no significant influence. Conclusions The clear majority (70.1%) of trials of labor after caesarean resulted in vaginal delivery. High body mass index, no previous spontaneous delivery, and fetal distress as a cesarean indication correlated negatively with a successful vaginal birth after cesarean. These factors should be used for the consultation of pregnant women.

scholarly journals Risk Factors for Intrapartum Cesarean Section Delivery in Low-risk Multiparous Women Following at Least a Prior Vaginal Birth (Robson Classification 3 and 4)

2021 ◽  
Vol 43 (06) ◽  
pp. 436-441
Author(s):  
Gul Nihal Buyuk ◽  
Hatice Kansu-Celik ◽  
Zeynep Asli Oskovi Kaplan ◽  
Burcu Kisa ◽  
Sule Ozel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cesarean Section ◽  
Fetal Distress ◽  
Vaginal Birth ◽  
Low Risk ◽  
Cervical Dilatation ◽  
Abdominal Circumference ◽  
Robson Classification ◽  
Multiparous Women ◽  
History Of

Abstract Objective The aim of the present study was to evaluate the risk factors for cesarean section (C-section) in low-risk multiparous women with a history of vaginal birth. Methods The present retrospective study included low-risk multiparous women with a history of vaginal birth who gave birth at between 37 and 42 gestational weeks. The subjects were divided into 2 groups according to the mode of delivery, as C-section Group and vaginal delivery Group. Risk factors for C-section such as demographic characteristics, ultrasonographic measurements, smoking, weight gain during pregnancy (WGDP), interval time between prior birth, history of macrosomic birth, and cervical dilatation at the admission to the hospital were obtained from the charts of the patients. Obstetric and neonatal outcomes were compared between groups. Results The most common C-section indications were fetal distress and macrosomia (33.9% [n = 77 and 20.7% [n = 47] respectively). A bivariate correlation analysis demonstrated that mothers aged > 30 years old (odds ratio [OR]: 2.09; 95% confidence interval [CI]: 1.30–3.34; p = 0.002), parity >1 (OR: 1.81; 95%CI: 1.18–2.71; p = 0.006), fetal abdominal circumference (FAC) measurement > 360 mm (OR: 34.20; 95%CI: 8.04—145.56; p < 0.001)) and < 345 mm (OR: 3.06; 95%CI: 1.88–5; p < 0.001), presence of large for gestational age (LGA) fetus (OR: 5.09; 95%CI: 1.35–19.21; p = 0.016), premature rupture of membranes (PROM) (OR: 1.52; 95%CI: 1–2.33; p = 0.041), and cervical dilatation < 5cm at admission (OR: 2.12; 95%CI: 1.34–3.34; p = 0.001) were associated with the group requiring a C-section. Conclusion This is the first study evaluating the risk factors for C-section in low-risk multiparous women with a history of vaginal birth according to the Robson classification 3 and 4. Fetal distress and suspected fetal macrosomia constituted most of the C-section indications.

scholarly journals Anandamide Exerts a Differential Effect on Human Placenta Before and After the Onset of Labor

2021 ◽  
Vol 12 ◽  
Author(s):  
Paula Accialini ◽  
Cyntia Abán ◽  
Tomás Etcheverry ◽  
Mercedes Negri Malbrán ◽  
Gustavo Leguizamón ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
Endocannabinoid System ◽  
Cesarean Sections ◽  
Vaginal Deliveries ◽  
Before And After ◽  
Elective Cesarean ◽  
Main Components ◽  
Relevant Finding

The onset of labor involves the action of multiple factors and recent reports have postulated the endocannabinoid system as a new regulator of this process. Our objective was to study the role of anandamide, one of the main endocannabinoids, on the regulation of placental molecules that contribute to the onset of labor at term. Placental samples were obtained from patients with laboring vaginal deliveries and from non-laboring elective cesarean sections. Vaginal delivery placentas produced higher prostaglandins levels than cesarean section samples. Besides, no differences were observed in NOS basal activity between groups. Incubation of vaginal delivery placentas with anandamide increased prostaglandins concentration and decreased NOS activity. Antagonism of type-1cannabinoid receptor (CB1) did not alter the effect observed on NOS activity. Conversely, incubation of cesarean section placentas with anandamide reduced prostaglandins levels and enhanced NOS activity, the latter involving the participation of CB1. Furthermore, we observed a differential expression of the main components of the endocannabinoid system between placental samples, being the change in CB1 localization the most relevant finding. Our results suggest that anandamide acts as a modulator of the signals that regulate labor, exerting differential actions depending on CB1 localization in laboring or non-laboring term placentas.

Timing and Safety of Postpartum Enoxparin.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4110-4110
Author(s):  
Rachel A. Freedman ◽  
Jeffrey Zwicker ◽  
Kenneth Alan Bauer
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
Postpartum Hemorrhage ◽  
Postpartum Period ◽  
Retrospective Cohort ◽  
Low Molecular Weight Heparin ◽  
Control Group ◽  
Low Molecular Weight ◽  
Cesarean Sections ◽  
Vaginal Deliveries

Abstract The appropriate time to restart anticoagulation in the postpartum period is not known. Both the American College of Obstetrics and Gynecology as well as American College of Chest Physicians (ACCP) have issued guidelines regarding the use of anticoagulants during pregnancy but neither have generated recommendations regarding the timing of the first dose of low-molecular-weight heparin (LMWH) in the postpartum period. The incidence of postpartum hemorrhage was assessed in a retrospective cohort study of 95 women treated with enoxaparin and compared with 303 consecutive deliveries where anticoagulation was not administered. The rate of severe postpartum hemorrhage did not differ significantly for women treated with peripartum enoxaparin versus a control group of women undergoing vaginal delivery (3.6% versus 1.4%, P=0.72) or cesarean section (5.1% versus 3.4%, P=0.98). There were no severe postpartum hemorrhages following the re-initiation of enoxaparin postpartum. In 75% of vaginal deliveries and 49% of cesarean sections, enoxaparin was restarted within 24 hours. Two incisional hematomas were observed in the group of women who received enoxaparin within 24 hours following cesarean section. We conclude that severe postpartum hemorrhage is an infrequent complication following the administration of enoxaparin postpartum. In support of current clinical practice, enoxaparin can be safely administered 0 to 24 hours following vaginal delivery and 12 to 36 hours following cesarean section.

scholarly journals CAESAREAN SECTION: PROBLEMS AND PROSPECTS IN THE REPUBLIC OF CRIMEA

2021 ◽  
pp. 57-68
Author(s):  
O.P. Miklin ◽  
I.S. Glazkov ◽  
I.B. Glazkova ◽  
Z.S. Rumyantseva ◽  
N.A. Reznichenko ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Breech Presentation ◽  
Maternity Hospital ◽  
Critical Conditions ◽  
Cesarean Sections ◽  
Robson Classification ◽  
The Republic ◽  
Uterine Scar ◽  
Abdominal Delivery

Caesarean section (CS) is a surgical procedure performed only in critical conditions to save the life of a mother and a child. The operation should be performed only if clinically indicated. Recently, the rate of cesarean sections is growing, but the number of deaths is not decreasing. The purpose of the study is to examine the frequency of abdominal delivery in Simferopol, Simferopol Clinical Maternity Hospital No. 2, to assess the possibilities and reserves for CS reduction in the region. Methods. The authors used retrospective analysis of birth histories according to Robson classification. Results. In 2018–2019 the frequency of cesarean sections in Simferopol Clinical Maternity Hospital No. 2 increased by 3 %. It was found out that primigravida and multipara with a uterine scar in the cephalic presentation are a reserve to decrease the indicator. It may also be promising to reduce the incidence of cesarean section in pregnant women with breech presentation. Keywords: caesarean section, Robson classification, Republic of Crimea. Операция кесарева сечения является методом, проводимым только при угрожающих состояниях с целью спасения жизни матери и ребенка. Операция должна выполняться только при строгих показаниях врача. В последнее время тенденция к родоразрешению путем кесарева сечения нарастает, однако число летальных исходов не уменьшается. Цель. Определение частоты абдоминального родоразрешения в г. Симферополь на примере ГБУЗ РК «Симферопольский клинический родильный дом № 2» и оценка возможностей и резервов ее снижения в регионе. Материалы и методы. Ретроспективный анализ историй родов по классификации Робсона. Результаты. Частота кесарева сечения в ГБУЗ РК «Симферопольский клинический родильный дом № 2» в течение 2 лет возросла на 3 %. Было установлено, что резервом снижения данного показателя являются первобеременные и повторнородящие с рубцом на матке и с плодом в головном предлежании. Перспективным может быть также снижение частоты кесарева сечения у беременных с тазовым предлежанием. Ключевые слова: кесарево сечение, классификация Робсона, Республика Крым.

scholarly journals Episiotomy practices in France: epidemiology and risk factors in non-operative vaginal deliveries

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Clesse Christophe ◽  
Cottenet Jonathan ◽  
Lighezzolo-Alnot Joelle ◽  
Goueslard Karine ◽  
Scheffler Michele ◽  
...  
Keyword(s):  
Risk Factors ◽  
Breech Presentation ◽  
Population Based ◽  
Protective Effects ◽  
Factors Associated ◽  
Nulliparous Women ◽  
Vaginal Deliveries ◽  
Multiparous Women ◽  
Scarred Uterus ◽  
Hospital Teams

AbstractEpisiotomy use has decreased due to the lack of evidence on its protective effects from maternal obstetric anal sphincter injuries. Indications for episiotomy vary considerably and there are a great variety of factors associated with its use. The aim of this article is to describe the episiotomy rate in France between 2013 and 2017 and the factors associated with its use in non-operative vaginal deliveries. In this retrospective population-based cohort study, we included vaginal deliveries performed in French hospitals (N = 584) and for which parity was coded. The variable of interest was the rate of episiotomy, particularly for non-operative vaginal deliveries. Trends in the episiotomy rates were studied using the Cochran-Armitage test. Hierarchical logistic regression was used to identify variables associated with episiotomy according to maternal age and parity. Between 2013 and 2017, French episiotomy rates fell from 21.6 to 14.3% for all vaginal deliveries (p < 0.01), and from 15.5 to 9.3% (p < 0.01) for all non-operative vaginal deliveries. Among non-operative vaginal deliveries, epidural analgesia, non-reassuring fetal heart rate, meconium in the amniotic fluid, shoulder dystocia, and newborn weight (≥ 4,000 g) were risk factors for episiotomy, both for nulliparous and multiparous women. On the contrary, prematurity reduced the risk of its use. For nulliparous women, breech presentation was also a risk factor for episiotomy, and for multiparous women, scarred uterus and multiple pregnancies were risk factors. In France, despite a reduction in episiotomy use over the last few years, the factors associated with episiotomy have not changed and are similar to the literature. This suggests that the decrease in episiotomies in France is an overall tendency which is probably related to improved care strategies that have been relayed by hospital teams and perinatal networks.

scholarly journals Gestational Risk as a Determining Factor for Cesarean Section according to the Robson Classification Groups

2021 ◽  
Author(s):  
Karina Biaggio Soares ◽  
Vanessa Cristina Grolli Klein ◽  
José Antônio Reis Ferreira de Lima ◽  
Lucas Gadenz ◽  
Larissa Emile Paulo ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Pregnant Women ◽  
Tertiary Hospital ◽  
Cesarean Sections ◽  
Cross Sectional ◽  
Regional Referral Hospital ◽  
Robson Classification ◽  
Vaginal Deliveries ◽  
Delivery Routes ◽  
Birth Records

Abstract Objective To analyze and compare the frequency of cesarean sections and vaginal deliveries through the Robson Classification in pregnant women attended at a tertiary hospital in two different periods. Methods Cross-sectional, retrospective study of birth records, comprising 4,010 women, conducted from January 2014 to December 2015 in the only public regional referral hospital for the care of high- risk pregnancies, located in Southern Brazil. Results The overall cesarean section rate reached 57.5% and the main indication was the existence of a previous uterine cesarean scar. Based on the Robson Classification, groups 5 (26.3%) and 10 (17.4%) were the most frequent ones. In 2015, there was a significant increase in the frequency of groups 1 and 3 (p < 0.001), when compared with the previous year, resulting in an increase in the number of vaginal deliveries (p < 0.0001) and a reduction in cesarean section rates. Conclusion The Robson Classification proved to be a useful tool to identify the profile of parturients and the groups with the highest risk of cesarean sections in different periods in the same service. Thus, it allows monitoring in a dynamic way the indications and delivery routes and developing actions to reduce cesarean rates according to the characteristics of the pregnant women attended.

scholarly journals VAGINAL BIRTH AFTER CAESAREAN SECTION;

2013 ◽  
Vol 20 (05) ◽  
pp. 759-764
Author(s):  
SANA ZAHIRUDDIN ◽  
SUMERA RAUF QURESHI ◽  
UMER FAROOQ
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Vaginal Delivery ◽  
Breech Presentation ◽  
Vaginal Birth ◽  
University Hospital ◽  
Cross Sectional ◽  
Study Results ◽  
Previous Cesarean ◽  
Vaginal Birth After Caesarean

Background: Cesarean section is the commonest obstetrical procedure, associated with increase in maternal morbidity,the cesarean section rate is steadily on the rise in our country which can give rise to a number of complications. Objective: To determinethe factors associated with successful vaginal delivery after previous cesarean section. Study Design: Cross sectional study. Period:May 2009 to October 2009. Setting: Liaquat university hospital, Hyderabad. Material and Methods: a total of 96 women which fulfilledthe selection criteria were included in the study. Results: The women included in the study had a mean age of+SD(range),29.94+4.41successful vaginal birth was observed in 57(59.5%) women and 39(40.6%) had an emergency repeat cesareandelivery. The factors favoring successful vaginal delivery were history of previous vaginal delivery and previous cesarean due to fetaldistress or breech presentation, and patients having cesarean due to non progress of labor and no prior vaginal delivery were less likely tohave a successful vaginal birth after having previous cesarean delivery. Conclusions: vaginal birth after caesarean section can berecommended in patients having prior vaginal delivery and previous caesarean due to fetal distress and breech presentation.

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