scholarly journals Critical analysis of surgical difficulties and postoperative morbidities of caesarean deliveries: a rural teaching hospital experiences in silk city, South India

2017 ◽  
Vol 6 (6) ◽  
pp. 2565
Author(s):  
Wills G. Sheela ◽  
Chellatamizh M. ◽  
Mohanambal M.
Keyword(s):  
Caesarean Section ◽  
Vaginal Delivery ◽  
Placenta Previa ◽  
Intraoperative Complications ◽  
Caesarean Section Rate ◽  
Uterine Cavity ◽  
Bladder Injury ◽  
Lower Segment ◽  
Excessive Bleeding ◽  
Cesarean Deliveries

Background: Caesarean section is the delivery of a fetus through a surgical incision on the uterine wall after 28 weeks of gestation. Objectives of present study were to determine the caesarean section rate, to analyse surgical difficulties and post-operative morbidites in caesarean deliveries and to formulate modalities to reduce morbidity and to ensure safe motherhood.Methods: Retrospective analysis of caesarean deliveries in Shri Sathya Sai Medical College and Research Institute, Ammapettai from January 2015-2017. Total number of delivery in these two year were 494.Total vaginal delivery-210, Total caesarean delivery-284. Case records of women who had cesarean deliveries were analysed for intra operative complications and post-operative morbidity within the period of their hospital stay.Results: Total no of deliveries in 2 years were 494. Vaginal delivery was 210 (42.5%). Total caesarean section is 57.5% (n=284). Primary caesarean section rate 33.1% (n=94) and secondary cesarean section rate 66.9% (n=190). 60% of our subjects were un-booked emergency admissions. Majority were between 21-30 years. Youngest is 16yr old with imminent eclampsia, oldest 35yr with previous 3 LSCS with central placenta previa. Non-closure of peritoneum in previous caesarean has increased the risk of adhesions, plastered rectus muscle and bladder adhesion which caused difficulty in reaching lower segment in 62 women. In present study, vertical incision was put on uterus in 4 cases due to adhesions. Difficulty in entering uterine cavity, extension of uterine angle due to thick lower segment and excessive bleeding was seen in cases of repeat caesarean section. Scar dehiscence has increased due to single layer closure of uterus. Scar dehiscence was noted in 41 cases. Bladder injury in 3 cases, adherent placenta over the scar was seen in 5 cases.Conclusions: Caesarean section rate is increasing. Intraoperative complications and postoperative morbidity is comparatively less in primary caesarean section. More than one morbidity was seen in 60% women who had repeat section. With the growing rate of cesarean deliveries worldwide, women should be counselled that the repeat cesarean are bound with surgical difficulties and complications. If available, it’s imperative to take the senior obstetricians help for better surgical outcome. Anticipation of complications, early decision and active intervention reduces morbidity and prevent mortality as most of the women report for admissions late in labour.

Study on Maternal and Neonatal Outcome of women undergoing Caesarean Section using Nice Classification in a Tertiary Care Hospital in Rural Area of Central India - An Observational Prospective Study

2021 ◽  
Vol 17 ◽  
Author(s):  
Shuchi M. Jain ◽  
Ketki. Thool ◽  
Manish A. Jain ◽  
Poonam V. Shivkumar
Keyword(s):  
Caesarean Section ◽  
Prospective Study ◽  
Neonatal Outcome ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Central India ◽  
Neonatal Morbidity ◽  
Bladder Injury ◽  
Care Hospital ◽  
Chi Square

Background : Caesarean section is often perceived to be safer than vaginal delivery for mothers and neonates, and thus has become increasingly common around the globe. However, it may actually be detrimental to maternal and neonatal health while consuming valuable resources. Objective : The objective of this study was to categorize the caesarean sections performed in our rural institute into various categories using NICE classification and to study the maternal and neonatal outcome in them. Method : This was a prospective study of all women who underwent caesarean section over a period of 18 months. Data was retrieved from the files of women for morbiditiy and mortality in mothers and babies. Data was entered in MS excel sheet and analyzed with percentages and chi square test using SPSS ver.17. Results: Caesarean section rate (CSR) was 36.88%. All CS were classified into four categories based on urgency as per NICE guidelines. There were 22.62% women in Category I, 38.61% in category II, 28.37% in category III and 10.40% in Category IV. Adhesions, extension of angle, lacerations in lower segment, scar dehiscence, atonic PPH and bladder injury were noted in (12.83%), 11.81%, 6.83%, 4.08% , 1.53% and 0.08% CS respectively. Caesarean hysterectomy was done in 0.24% cases. Postoperative morbidity was febrile morbidity (11.93%), postdural puncture headache (13.85%), paralytic ileus (11.49%), wound infection (8.83%), ARDS (0.70%), sepsis (0.78%), pulmonary edema (0.47%) and pulmonary embolism (0.03%). Maternal mortality was 0.03%. Neonates born were 2577 (29 were twin deliveries). 82.46% neonates were healthy, 16.80% had morbidities and 0.74% were still born. Apgar score of less than 7 was in 10%. 16.80% neonates were admitted in NICU during their hospital stay. Neonatal mortality was 1.47%. Conclusion : Intraoperative and post-operative complication were more in caesarean sections of category I and II as compared to category III and category IV. Neonatal morbidity, mortality and admissions to NICU were more in caesarean sections of category I and II as compared to category III and category IV. Thus though caesarean section is an emergency lifesaving procedure for mother and baby it may prove detrimental to their health.

scholarly journals Epidemiological, clinical, prognostic and therapeutic aspects of twin delivery in two referral maternity units in Dakar (Senegal)

2018 ◽  
Vol 7 (2) ◽  
pp. 364
Author(s):  
Omar Gassama ◽  
Magatte Mbaye ◽  
Aminata Niass ◽  
Diodio Boye ◽  
Babacar Biaye ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Twin Pregnancy ◽  
Placenta Previa ◽  
Uterine Cavity ◽  
Breech Presentation ◽  
Premature Delivery ◽  
Time Interval ◽  
Maternal Complications ◽  
Twin Delivery ◽  
Second Twin

Background: Twin pregnancy is the simultaneous development of two embryos and then two fetuses in the uterine cavity. Objective of present study was to assess the epidemiological, clinical, prognostic and therapeutic aspects of twin delivery in two referral maternity units in Dakar.Methods: A descriptive and analytical retrospective bi-centric study of all cases of twin deliveries recorded in two referral center in Dakar was conducted during the period January 1st, 2005-December 31st, 2015, i.e. an 11-year period. It concerned 619 pregnant women who gave birth to twins in these two referral medical structures. The epidemiological parameters, clinical, prognostic and therapeutic aspects of twin childbirth were studied. The data were entered and analysed using Epi info version 3.5.3.Results: The twinning prevalence was 1.11%. The majority of our parturient women (506 or 81.7% of the cases) came from the Dakar suburbs. The average age of the parturient women was 28 years and the gestity age 3.1. Pregnancy was well monitored for 98.5% of the parturient women with an average number of prenatal consultations of 3.6. The first prenatal consultation was performed in 52% of cases in the first quarter. In more than one third of cases (234 or 37.8%), the diagnosis was made in the third quarter of pregnancy. 113 cases (18.2%) of premature rupture of membranes, 10 cases (1.61%) of threat of premature delivery and 7 cases (11.13%) of placenta previa were registered. During labour, the diagnosis was made by clinical examination in 32.2% of cases. Bichorial biamniotic twin pregnancy was the most frequent anatomical type (62.6%). On admission, the first twin (T1) was in cephalic presentation in 56.7%, in breech presentation in 15.2%; The second twin (T2) was in breech presentation in 21.1% of the cases. Caesarean section was related to the first twin in 50.6% and the second twin in 53.8% of the cases. Caesarean section was performed in 50.6% for the first twin and in 53.8% for the second twin. The mean time interval between the delivery of T1 and that of T2 was 17.4 min. Low birth weight was more frequent for the second twin (54.3%). The stillbirth rate was 48.26 per thousand. Maternal complications were dominated by renal-vascular syndromes (4.2%), haemorrhagic causes (1.86%), perineal lesions (1.6%) and uterine rupture (0.97%). Postpartum haemorrhage was observed in 8 cases (1.29%). Maternal mortality was nilConclusions: Twin delivery poses varying difficulties due to the complexity of obstetrical mechanics and the frequency of dystocic presentations. Despite improved maternal prognosis, in recent years, perinatal mortality and morbidity, still high, remain a constant concern.

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 Caesarean section: its rates and indications at a tertiary referral center in Eastern Nepal

1970 ◽  
Vol 9 (3) ◽  
pp. 179-183
Author(s):  
S Chhetri ◽  
U Singh
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Placenta Previa ◽  
Caesarean Section Rate ◽  
Breech Presentation ◽  
Fetal Distress ◽  
Tertiary Referral ◽  
Common Indication ◽  
Tertiary Referral Center ◽  
Referral Center

Background: There has been a sustained increase in the rate of caesarean section in the last few years around the world. Data regarding the current caesarean rate and the trends of its indications in eastern Nepal have not been estimated earlier. Aim: To assess the rate of caesarean sections and the varying indications for caesarean section in a tertiary referral center in eastern Nepal. Methods: All hospital deliveries that took place in BPKIHS between January 2006 and December 2007 were recorded to assess the caesarean section rate and its indications. Results: A total of 5330 deliveries were conducted in 2006. Likewise the total number of deliveries conducted in 2007 was 6634. In 2006 caesarean sections were performed in 28.6% (1524) of all patients. The rate of caesarean sections in 2007 increased and was 33.7% (2239). The most common indication for caesarean section was meconiumstained liquor, which constituted 23.4% (883). The next frequent indication was previous caesarean section, which accounted for 17.2% (650), followed by breech presentation in 11.1% (417), fetal distress in 9.6% (364), non-progress of labor in 7.2% (270), cephalopelvic disproportion in 6.2% (234, and placenta previa in 4.4% (165). Conclusions: There is a increasing trend of performing cesarean section in the tertiary referral center in east era Nepal. The most common indication for cesarean section is meconium-stained liquor. Keywords: Caesarean section; caesarean delivery rates; Nepal DOI: http://dx.doi.org/10.3126/hren.v9i3.5587   HR 2011; 9(3): 179-183

scholarly journals An analytical study of intraoperative, immediate post-operative and perinatal complications in previous two caesarean section

2018 ◽  
Vol 7 (10) ◽  
pp. 4239
Author(s):  
Prachi Singh ◽  
Ritika Agarwal ◽  
Shweta Yadav
Keyword(s):  
Caesarean Section ◽  
Analytical Study ◽  
Placenta Previa ◽  
Morbidity And Mortality ◽  
Perinatal Morbidity ◽  
Perinatal Complications ◽  
Lower Segment ◽  
Lower Segment Caesarean Section ◽  
Adherent Placenta ◽  
Maternal Morbidity And Mortality

Background: Lower segment caesarean section is one of the commonest operations performed now a day.It has been seen that in cases with previous caesarean section there is increased maternal morbidity and mortality due to placenta previa, adherent placenta and caesarean hysterectomy.The present study was conducted to know the fetomaternal outcome and intra and immediate post-operative complications in cases with previous two lower segment caesarean section.Methods: The present study was conducted in TMMC Moradabad between January 2017-January 2018.Total 68 cases were previous two lower segment caesarean section were included in the study. Neonatal outcome and intraoperative and immediate postoperative complications were seen in these cases.Results: In the present study majority of the cases were in 30-34 years age group (39.7%), the maximum number of caesarean sections were done between gestational age of 37-39.6 weeks (47.1%). Intraoperatively adhesions between uterus, anterior abdominal wall and bladder was seen in less than half of the cases i.e. in 42.6% cases. Out of 68 cases with previous two lower segment caesarean operated 13 cases had placenta previa and 4 cases had adherent placenta.Conclusions: The present study shows that the maternal and perinatal morbidity and mortality is increased with increasing number of caesarean sections. So, there should be reduction in rate of primary caesarean section which can reduce the rate of placenta previa and adherent placenta in subsequent pregnancies.

scholarly journals A cross sectional study of 1000 lower segment cesarean section in obstetrics and gynecology department of P. D. U Medical College, Rajkot, Gujarat, India

2017 ◽  
Vol 6 (4) ◽  
pp. 1186
Author(s):  
Dolly Chavda ◽  
Kamal Goswam ◽  
Kavita Dudhrejiya
Keyword(s):  
Caesarean Section ◽  
Caesarean Section Rate ◽  
Fetal Distress ◽  
Cross Sectional Study ◽  
Obstetrics And Gynecology ◽  
Sectional Study ◽  
Lower Segment ◽  
Cross Sectional ◽  
Medical College ◽  
Lower Segment Cesarean Section

Background: Though WHO recommends a rate of 10-15% caesarean section for a given hospital, there has been a rising trend worldwide. We estimated the recent incidence of caesarean section in Obstetrics and Gynecology Department, P.D.U. Medical College, Rajkot (Gujarat and correlated these rates with the socioeconomic, demographic, and health variables.Methods: We have studied 1000 cases of lower segment caesarean section (cross sectional study) at Obstetrics and Gynecology Department, P.D.U Medical College, Rajkot (Gujarat) to find out rate of caesarean section, common maternal and fetal indication and complications of lower segment caesarean section.Results: Caesarean section rate of the present study is 19.9%. Most common indication of LSCS was scarred uterus 39.9%.followed by fetal distress 19.1%, malpresentation 18.6%, and failed induction 7.3%. Maternal morbidities and mortalities in emergency LSCS in compare to elective LSCS. Analysis based on Robson’s ten-group showed that group 5 (Previous CS, single cephalic,>37 weeks) made the greatest contribution to total CS rate.Conclusions: Scientific advances, social and cultural changes, and medico legal considerations seem to be the main reasons for the increased acceptability of caesarean sections. The decision to perform a C-section delivery must be chosen carefully and should not be profit oriented. There is a possibility of keeping the rate to minimum by reducing number of primary caesarean sections, by proper counseling of the patients, proper monitoring and patience.

scholarly journals Study of the efficacy of tranexamic acid in reducing blood loss after child birth

2021 ◽  
Vol 10 (5) ◽  
pp. 1863
Author(s):  
Nagajyothi Gunturu ◽  
D. Shivani ◽  
P. Sravanthi
Keyword(s):  
Caesarean Section ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Vaginal Delivery ◽  
Active Management ◽  
Control Group ◽  
Study Group ◽  
Lower Segment ◽  
Lower Segment Caesarean Section ◽  
Third Stage

Background: The aim was to study the efficacy of tranexamic acid in reducing blood loss after childbirth in normal vaginal delivery and LSCS.Methods: 200 pregnant women divided into two groups group 1 and group 2, 100 women undergoing LSCS and 100 women undergoing vaginal delivery. Study group will be given 1 g iv tranexamic acid along with active management of third stage of labor and control subjects will be given only active management of third stage. Clinical observations and laboratory examinations, measurement of blood loss were measured.Results: Distribution with respect to indication of LSCS like fetal distress, cephalopelvic disproportion, abnormal presentation, previous LSCS, arrest of descent, failed induction and onset of labor were comparable between both the groups. Study group showed marked decrease in blood loss when compared to controls from time of placental delivery to 2 hours postpartum in women undergoing vaginal delivery and caesarean section. There was a significant fall in mean Hb level among the control group when compared with the study group. There was no significant difference in the vital signs of the subjects in both the groups. The incidence of adverse effect like nausea, vomiting and diarrhoea were not increased in the study group when compared to the control group. Also the incidence of thrombosis was not increased with tranexamic acid.Conclusions: Tranexamic acid significantly reduced the amount of blood loss after vaginal delivery and lower segment caesarean section. Its use was not associated with any adverse drug reactions like nausea, vomiting, diarrhoea or thrombosis. Tranexamic acid can be safely administered in pregnant women undergoing vaginal delivery and lower segment caesarean section. 

scholarly journals The maternal and fetal outcome of repeat previous one caesarean section

2021 ◽  
Author(s):  
Uma Jain ◽  
Deepali Jain ◽  
Shaily Sengar ◽  
Preeti Gupta
Keyword(s):  
Caesarean Section ◽  
Placenta Previa ◽  
Birth Asphyxia ◽  
Neonatal Morbidity ◽  
Fetal Distress ◽  
Fetal Outcome ◽  
Bladder Injury ◽  
History Of ◽  
Caesarean Hysterectomy ◽  
Placenta Accrete

Background: The rates of adverse maternal and neonatal outcomes have increased significantly in the last decade. Patients with repeated caesarean deliveries also have a greater risk of placenta previa, placenta accrete, uterine rupture, bowel and bladder injury, and unplanned hysterectomy.Methods: This retrospective study was performed between 01 April 2017 to 31 March 2021, at a private hospital to know about the surgical difficulties and maternal and neonatal complications encountered in cases of repeated LSCS. The outcome of 1028 women admitted with a history of previous LSCS was studied.Results: The 613 patients were given a trial of labour. 40.07% of patients delivered normally. The most common indication for repeat LSCS was CPD in 20.94% and fetal distress 20.12%. The most common complication observed was adhesion in 37.65%. Scar dehiscence in 8.92 %, scar rupture in 0.64%, uterine atony in 4.8%, placenta previa in 3.57%, placenta accrete in 0.64%, injury to the bladder was seen in 0.97%, caesarean hysterectomy was done in only 2 cases and gaped wound was found in 1.13% of cases. 19.15% of neonates were admitted to NICU. Apgar score <7 at 5 minutes in 14.77%. premature neonates were 8.44% RDS was found in 7.62%, birth asphyxia was found in 2.92% cases and neonatal sepsis was found in 1.13%.Conclusions: The dramatic increase in caesarean section rates over the past three decades has been associated with a corresponding increase in maternal morbidity but there a continuous decrease in neonatal morbidity and mortality rates because of advances in neonatal medicine.

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