Lateral Approach Technique to Minimize Bladder Injury During Abdominal Hysterectomy in Cases with Previous Cesarean Sections: An Observational Study

The presence of placenta previa may be associated with placenta accreta[1]. Maternal and fetal morbidity and mortality from placenta previa accreta are considerable and are associated with high demands on health resources. With the rising incidence of caesarean sections combined with increasing maternal age, the number of cases of placenta praevia and its complications, including placenta accreta, will continue to increase[2]. Here, we present a case of placenta previa totalis percreta in previous cesarean section twice. In this case, patient with placenta previa totalis-percreta we diagnosed and prepared proper management with the involvement of multidisciplinary team. We reduced blood loss by performing total abdominal hysterectomy immediately after delivered the baby and the postoperative course was uneventful.Keywords: Cesarean Section-Hysterectomy, placenta accreta, placenta percreta, placenta previa

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Complete Uterine Rupture a Stigma for Modern Obstetrics: An Observational Study

Current Women s Health Reviews ◽

10.2174/1573404817999201230234732 ◽

2020 ◽

Vol 17 ◽

Author(s):

Naina Kumar ◽

Ashu Yadav

Keyword(s):

Observational Study ◽

Cesarean Section ◽

Rural Areas ◽

Uterine Rupture ◽

Perinatal Outcome ◽

Morbidity And Mortality ◽

Bladder Injury ◽

Previous Cesarean Section ◽

Tertiary Center ◽

Previous Cesarean

Aims:: To know the and maternal and perinatal outcome in women with complete uterine rupture. Background: Uterine rupture is a catastrophic obstetric event associated with high maternal, perinatal morbidity and mortality. Objectives: The present study was conducted to know prevalence, risk factors, presentation, maternal, perinatal outcome in women with complete uterine rupture. Methods:: Present retrospective observational study was conducted on 31 women admitted to Obstetrics ward of rural tertiary center of Northern India with complete uterine rupture between January 2016 and December 2018 after Institutional ethical committee approval and informed written consent from participants. Data included socio-demographic parameters, gestation, predisposing factors, clinical features, site of rupture, associated bladder injury, need for hysterectomy, perinatal and maternal outcome. Statistical analysis was done using Statistical Package for the Social Sciences software version 22.0. Results:: Of total 9,156 deliveries during study period 31 women had uterine rupture, indicating prevalence of 0.34%. Of all, 21(67.7%) women had unscarred uterine rupture and 10(32.3%) scarred uterine rupture. Majority cases were un-booked (77.4%), multiparous (90.3%) and term at gestation (66.7%) with an average age of all cases as 26.97±3.73 years. Most common risk factor was injudicious use of oxytocic (29.0%) and previous cesarean section scar (22.6%). Most common site of unscarred uterine rupture was lower uterine segment (26.7%) and in scarred uterus, site of previous cesarean section (26.7%). Eight (25.8%) women had bladder injury. Total 24(77.4%) fetuses were stillborn. Seventeen (54.8%) women needed hysterectomy as lifesaving procedure and three (9.7%) succumbed to death despite of all resuscitative measures. Conclusion:: Hence, complete uterine rupture is common in rural areas and is serious obstetric emergency with high perinatal, maternal morbidity and mortality. Other: As most of the cases of complete uterine rupture occur in unbooked women, hence, motivating all antenatal women for regular antenatal visits can prevent the dreadful condition to a large extent, thereby saving many maternal and fetal lives.

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A Planned Cesarean Section-Hysterectomy for Placenta Previa Totalis Percreta in Patient with History of Two Cesarean Sections

Medicinus ◽

10.19166/med.v7i1.1442 ◽

2019 ◽

Vol 7 (1) ◽

pp. 13

Author(s):

Julita Nainggolan

Keyword(s):

Cesarean Section ◽

Placenta Accreta ◽

Placenta Previa ◽

Health Resources ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Cesarean Sections ◽

History Of ◽

Rising Incidence ◽

Previous Cesarean

The presence of placenta previa may be associated with placenta accreta[1]. Maternal and fetal morbidity and mortality from placenta previa accreta are considerable and are associated with high demands on health resources. With the rising incidence of caesarean sections combined with increasing maternal age, the number of cases of placenta praevia and its complications, including placenta accreta, will continue to increase[2]. Here, we present a case of placenta previa totalis percreta in previous cesarean section twice. In this case, patient with placenta previa totalis-percreta we diagnosed and prepared proper management with the involvement of multidisciplinary team. We reduced blood loss by performing total abdominal hysterectomy immediately after delivered the baby and the postoperative course was uneventful.

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A study of intra-operative maternal morbidity after repeating caesarean section

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175864 ◽

2017 ◽

Vol 7 (1) ◽

pp. 291

Author(s):

Sonali S. Somani ◽

Sunita Sudhir ◽

Shashikant G. Somani ◽

. Bushra

Keyword(s):

Caesarean Section ◽

Maternal Morbidity ◽

Intraoperative Complications ◽

Bladder Injury ◽

Cesarean Sections ◽

Intraoperative Complication ◽

Uterine Incision ◽

Operative Findings ◽

Caesarean Hysterectomy ◽

Previous Cesarean

Background: Caesarean section (CS) is one of the most common obstetric procedures worldwide and an increased rate of caesarean section has been observed in recent studies. Maternal morbidities and mortality associated with repeat caesarean section is an important health problem. The present study aims at knowing the various intraoperative complications encountered during repeat caesarean sections. Objective was to study the incidence and type of surgical difficulties encountered in repeat cesarean sectionsMethods: It was a prospective observational study of 118 cases of repeat cesarean sections. Intra-operative findings of all cases were analyzed to know the difficulties encountered because of previous cesarean section.Results: In present study, out of total 118 cases of previous cesarean sections, 71 (60.17%) cases were of previous one caesarean section and 47(39.83%) were of previous two cesarean sections. Following intraoperative morbidities were encountered – adhesions (1 caesarean section vs 2 caesarean section – 40.85 vs 65.96% respectively) , thin lower uterine segment (1 caesarean section vs 2 caesarean section – 21.13 vs 36.17% respectively), advanced bladder(1 caesarean section vs 2 caesarean section – 15.49 vs 36.17 % respectively) , extension of uterine incision(1 caesarean section vs 2 caesarean section – 9.86 vs 19.15% respectively) , scar dehiscence(1 caesarean section vs 2 caesarean section –7.04 vs 31.91% respectively), excess blood loss (1 caesarean section vs 2 caesarean section –7.04 vs 19.15% respectively), 1 case of placenta accrete was found in previous 2 caesarean section 2.13%) which needed caesarean hysterectomy. uterine rupture and bladder injury seen in one patients of previous 2caesarean section. Time taken for surgery was more in repeat CS group Delivery.Conclusions: An increasing number of CS is accompanied by increased maternal morbidity. Intraoperative complication which increase the risk of morbidity are adhesion, placenta accreta. It is prudent to involve a senior experienced obstetrician in repeat cesarean section. The best way to reduce this is by reducing primary caesarean section rates. Patients with previous caesarean section should be considered as high risk and should be counseled for regular antenatal check-up and they should be given option of vaginal birth after CS whenever possible.

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Prenatal ultrasound diagnosis of velamentous insertion of the umbilical cord: clinical cases and literature review

10.21516/2413-1458-2018-17-1-33-41 ◽

2018 ◽

Author(s):

M.A. Esetov , A.M. Esetov , I.V. Ramazanova

Keyword(s):

Umbilical Cord ◽

Color Doppler ◽

Color Doppler Ultrasound ◽

Ultrasound Diagnosis ◽

Cesarean Sections ◽

Previous Cesarean Section ◽

Vasa Previa ◽

Obstetrical Management ◽

Previous Cesarean ◽

Singleton Pregnancies

Seven cases of ultrasound diagnosis of velamentous insertion (VCI) of the umbilical cord at singleton pregnancies on 21–34 weeks of gestation are presented. The ultrasound picture two of the VIC types is presented: fixed in 5 cases and free in 2 cases. In one case the VCI was in the lower third of the uterus and the wound has been diagnosed the vasa previa. In other cases, the VCI was in middle third of the uterus. In all cases delivery was at 37–39.1 weeks of gestation. In 4 cases Cesarean sections were performed. In two of the VCI cases elective Ce sarean sections were performed for the following indications: previous Cesarean section and vasa previa. VCI can reliably be detected prenatally by gray-scale and color Doppler ultrasound. For fixed VCI located in the middle-upper of the uterus, no change in standard obstetrical management seems to be required.

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

Obstetrics & Gynecology International Journal ◽

10.15406/ogij.2021.12.00543 ◽

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.

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Pregnancy complicated by previous cesarean section: a retrospective study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184491 ◽

2018 ◽

Vol 7 (11) ◽

pp. 4470

Author(s):

Poornima M.

Keyword(s):

Retrospective Study ◽

Cesarean Section ◽

Medical Records ◽

Neonatal Outcome ◽

Perinatal Morbidity ◽

Cesarean Sections ◽

Previous Cesarean Section ◽

Exclusion Criteria ◽

History Of ◽

Previous Cesarean

Background: Previous Cesarean section (CS) is one of the important causes of CS in subsequent pregnancies. Moreover, repeated cesarean sections increase maternal as well as perinatal morbidity and mortality. We conducted this study to find out outcome of pregnancies in women who had a history of previous CS.Methods: This was a retrospective study of patients of previous caesarean section for either maternal or fetal indications. The duration of study was 3 years. Total 215 patients were included in this study on the basis of a predefined inclusion and exclusion criteria. The indications, maternal and neonatal outcome were studied from medical records of the patients. Statistical analysis was done using SSPE 22.0 software.Results: Out of 215 studied cases majority of the patients belonged to age group of 21-30 years (75.35%) and were 2nd gravida (61.86%). 164 (76.28%) patients attended ANC OPD at least for 3 times during pregnancy. 73 (33.95%) patients had Hb of less than 10 gms while blood transfusion was required to be given in 11 (5.12%) patients. cesarean section was required in 172 (80%) patients out of which 166 (77.21%) patients had undergone emergency LSCS while in 6 (2.79%) patients elective LSCS was done. Scar tenderness was the most common indication for repeat cesarean section. There was no maternal mortality in any patients while there was 1 still birth and 1 neonatal death.Conclusions: Previous cesarean section is one of the important causes of CS in subsequent pregnancies hence decision of doing CS, especially primigravida, must be taken in accordance with strict guidelines and the practice of “cesarean section on demand” should be discouraged.

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Analysis of Cesarean Sections using Robson’s Ten Group Classification System

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.37.2.3823 ◽

2021 ◽

Vol 37 (2) ◽

Author(s):

Rashida Parveen ◽

Mehnaz Khakwani ◽

Anum Naz ◽

Rabia Bhatti

Keyword(s):

Cesarean Section ◽

Classification System ◽

Fetal Distress ◽

Group Classification ◽

Care Hospital ◽

Cesarean Sections ◽

Previous Cesarean Section ◽

Group 10 ◽

Group 5 ◽

Previous Cesarean

Objective: To analyze trends of CSs and evaluating them according to Robson’s Ten Groups Classification System (TGCS) at a leading government tertiary care hospital of South Punjab, Pakistan. Methods: This cross-sectional study was conducted at Department of Obstetrics and Gynaecology, Nishtar Medical University Hospital, Multan Pakistan, from October 2019 to March 2020.The study population included a total of 167 women who underwent CS in the hospital during the specified study period. For each case, we collected data regarding maternal characteristics and pregnancy-related information. The dependent variable was Robson classification group. Results: Overall, mean age was 26.53+5.1 years. Majority of the women, 116 (69.5%) belonged to urban areas of residence, 74 (44.3%) gestational aged between 37-42 years while 108 (64.7%) had history of cesarean section. Most of the patients, 85 (50.9%) turned out to be from TGCS Group-10. Group-5 and Group-1 were the 2nd and 3rd most common group, accounted for 24 (14.4%) and 19 (11.4%) cases respectively. Previous cesarean section (20.4%) and fetal distress (19.8%) were found to be most common indications leading to cesarean section. Conclusion: As per Robson’s Ten-Group Classification, Group-10 and Group-5 were found to be the most contributing among deliveries done. Previous cesarean section and fetal distress were the most common indications of cesarean section. doi: https://doi.org/10.12669/pjms.37.2.3823 How to cite this:Parveen R, Khakwani M, Naz A, Bhatti R. Analysis of Cesarean Sections using Robson’s Ten Group Classification System. Pak J Med Sci. 2021;37(2):---------. doi: https://doi.org/10.12669/pjms.37.2.3823 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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