scholarly journals APPLYING THE ROBSON CLASSIFICATION TO FIND WAYS TO REDUCE THE FREQUENCY OF CESAREAN SECTION OPERATIONS

2020 ◽  
Vol 74 (2) ◽  
pp. 87-90
Author(s):  
L.V. Tkachenko ◽  
◽  
T.A. Verovsky ◽  
T.I. Kostenko ◽  
T.V. Skladanowsky ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Risk Groups ◽  
Birth Canal ◽  
Robson Classification ◽  
Pregnancy And Childbirth ◽  
Natural Birth ◽  
Risk Patients ◽  
Level 3 ◽  
Rational Management ◽  
Personalized Approach

The outcomes of pregnancy and childbirth, which ended with a cesarean section, were studied in accordance with Robson's classification in order to find ways to reduce the frequency of surgical delivery in a level 3 hospital. The mechanisms to reduce the frequency of cesarean section in an obstetric hospital are defined: pregravid preparation in risk groups for preterm delivery and assessment of perinatal risk factors, a personalized approach to methods of pre-induction of parturition in high-risk patients, especially in full-term pregnancy, rational management of parturition, prevention of the first cesarean section, an increase in delivery through the natural birth canal in pregnant women with a scar on the uterus.

Somatic dysfunctions in children of the first year of life: features of formation

2021 ◽  
pp. 34-44
Author(s):  
Yu. O. Kuzmina ◽  
E. S. Tregubova ◽  
E. S. Mokhova ◽  
Yu. P. Potekhina
Keyword(s):  
Statistical Significance ◽  
Statistical Processing ◽  
First Year ◽  
Term Infants ◽  
North West ◽  
Birth Canal ◽  
Pregnancy And Childbirth ◽  
Natural Birth ◽  
First Year Of Life ◽  
Physiological Childbirth

Introduction. The health status of children of the first year of life is primarily affected by the course of pregnancy and childbirth, as well as hereditary factors. During the newborn period, reversible disorders may occur, which can be estimated as somatic dysfunction (SD). The formation of SD in young children has its own causes and features, which have not been studied in detail until now.The goal of research — is to study the features of the osteopathic status in children of the first year of life with different patterns of pregnancy and delivery methods for their mothers.Materials and methods. Since 2015, for 5 years, a prospective multicenter study has been conducted to investigate the osteopathic status of children of the first year of life under a single protocol in 6 cities of Russia, organized by the Institute of Osteopathy (St. Petersburg) and the Department of Osteopathy of Mechnikov North-West State Medical University. A total of 360 full-term infants aged 1 to 12 months with perinatal hypoxic-ischemic lesions of the central nervous system, and practically healthy ones were examined. All children underwent an osteopathic examination, and a detailed history of pregnancy and childbirth was collected. Based on the results of the obstetric history analysis the following groups were selected: physiological course of pregnancy, ending in physiological childbirth through the natural birth canal — 62 people; physiological course of pregnancy, ending with operative delivery — 25 people; physiological course of pregnancy, ending in complicated labor through the natural birth canal — 20 people; pregnancy with complications, ending in physiological childbirth through the natural birth canal — 104 people. Statistical processing of the obtained results was carried out by nonparametric methods using the Statistica 10.0 software.Results. In children born by physiological childbirth with complicated pregnancy, a smaller number of local SD (p=0,04) and a larger number of global SD were detected, but the difference with the subgroup of the pregnancy physiological course did not reach the statistical significance. In children whose mothers had a physiological course of pregnancy, but childbirth proceeded with complications and required the use of obstetric assistance, the significantly more number of regional SD were revealed (p<0,0001) compared with children born in physiological childbirth. The latter had a greater number of local SD of the craniosacral system (p=0,035). In children born by caesarean section and in children born through the natural birth canal without complications, the number of global, regional and local SD did not differ statistically significantly. Osteopathic examination of children in the first year of life showed that the first three places in the structure of dominant SD were occupied by SD of the neck, head, and dura mater.Conclusion. Based on the data obtained as a result of the study, it can be assumed the presence of numerous factors that can lead to the formation of various SD in children of the first year of life during pregnancy and especially during childbirth. It is necessary to further study the features of the osteopathic state in children in the postnatal period.

Role of the audit of delivery methods for optimizing the indications for cesarean section and reducing its frequency in clinical practice

2021 ◽  
Vol 20 (2) ◽  
pp. 44-49
Author(s):  
A.A. Churganova ◽  
◽  
M.Kh. Gurzhikhanova ◽  
F.N. Alieva ◽  
S.I. Fedorina ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Fetal Distress ◽  
Labour Induction ◽  
Efficiency Coefficient ◽  
Delivery Methods ◽  
Robson Classification ◽  
Perinatal Center ◽  
Level 3 ◽  
Narrow Pelvis

Objective. To analyze the frequency of indications for cesarean section (CS) and optimize obstetric tactics on the example of a level 3 perinatal center. Materials and methods. We performed retrospective analysis of 7,672 deliveries. Results. The indications for CS included abnormal labour (150; 6.3%), fetal distress (120; 5%), placental abruption (60; 3%), and narrow pelvis (34; 1.4%). Most often (23%) CS was performed in patients with CS scars. Conclusion. The most important step towards reducing the proportion of CS is the change of the approaches to the use of labour induction methods and assessment of the fetus condition. It is extremely important to develop a comprehensive strategy for choosing an optimal delivery method in women with post-CS scars, as well as to perform thorough analysis of the indications for planned and emergency CS. Key words: caesarean section, Robson classification, efficiency coefficient

The Effective and Safety Use of the Epidural Analgesia at Vaginal Delivery in the Women with the Uterine Scar

10.12737/9077 ◽  
2015 ◽  
Vol 22 (1) ◽  
pp. 50-56
Author(s):  
Виноградов ◽  
V. Vinogradov ◽  
Густоварова ◽  
T. Gustovarova ◽  
Боженков ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Epidural Analgesia ◽  
Vaginal Delivery ◽  
Epidural Anesthesia ◽  
Apgar Score ◽  
Negative Effects ◽  
Birth Canal ◽  
Clinical Hospital ◽  
Natural Birth ◽  
Uterine Scar

The frequency of the Cesarean section leads to increase number of the patients with the scar on the uterus. In the Clinical hospital № 1 (Smolensk, Russia) the childbirth is carried out through natural birth canal on the women having a reliable scar on the uterus. The analysis of the vaginal delivery and labour outcomes in 69 patients with the scar on the uterus is carried out. The childbirth in 38 patients was conducted with the epidurals, in 31 patients – without this type of anesthesia. The efficiency and safety of the epidural anesthesia are shown. The obtained results confirm that the epidural anesthesia doesn&#180;t complicate the labour, doesn&#180;t increase the hospitalization term, doesn&#180;t influence the bleeding and negative effects on the fetus condition and the newborn assessment according to Apgar score. The possibility of using epidural anesthesia at childbirth on the women with uterine scar during the dystocia is shown.

Optimization approaches accouchement women with pregnancy using medical assisted reproductive technologies

2017 ◽  
pp. 123-126
Author(s):  
N.P. Goncharuk ◽  
◽  
N.R. Kovyda ◽  
Keyword(s):  
Cesarean Section ◽  
Key Words ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Etiologic Factor ◽  
Optimal Method ◽  
Birth Canal ◽  
Art Program ◽  
Natural Birth

The objective: to analyze the approaches to delivery of women with pregnancy after the application of curative programs of assisted reproductive technologies (ART). Patients and methods. In the process of the study, the approaches to the choice of the method of delivery of women after the application of ART were studied and analyzed. To achieve this goal, women were divided into two groups: the 1-st group – women after ART (2005-2009), whose delivery was performed in a conventional way, their number was 132 women; the 2-nd group – women after ART (2010-2014), whose delivery was performed according to the developed algorithm, their number was 162 women giving birth. Results. The comparative characteristics of the two groups established that the delivery of women after the use of assisted reproductive technologies (ART), which gave birth through the natural birth canal, in 70% ended with physiological labor. This trend indicates that the delivery of women after ART through the natural birth canal is one of the concepts for a significant reduction in the percentage of cesarean section (CS) in the hospital. Conclusion. To determine the optimal method of delivery in patients after ART, first of all, it is necessary to take into account the etiologic factor of infertility and the features of the course of pregnancy, and not the presence of an ART program in the history, as indications for the planned CS. Key words: auxiliary reproductive technologies, cesarean section.

Possibility of using of osteopathic methods of correction in the therapy of symphysiopathy in pregnant women

2021 ◽  
pp. 76-85
Author(s):  
E. N. Nenashkina ◽  
V. O. Belash
Keyword(s):  
Russian Literature ◽  
Pubic Symphysis ◽  
Pathological Process ◽  
Sacroiliac Joints ◽  
Functional Changes ◽  
Birth Canal ◽  
Pregnancy And Childbirth ◽  
Natural Birth ◽  
Synovial Membranes ◽  
Clear Description

A number of physiological changes occurring in a woman′s organism during pregnancy includes, among other things, structural and functional changes in the musculoskeletal system, manifested by softening of the ligaments, cartilage, synovial membranes of the pubic and sacroiliac joints, and as a result, there is some discrepancy pubic bones, which contributes to the safe passage of the fetus through the natural birth canal during childbirth. However, these changes can cross physiological boundaries, leading to excessive relaxation of the pelvic joints, the occurrence of pain and the risk of divergence of the pubic symphysis during pregnancy and childbirth. Despite a fairly clear description of this condition, until now there is no unified terminology for pathological changes in the pelvic bones during pregnancy. In the Russian literature the terms such as symphysitis, symphysiopathy, divergence and rupture of the pubic articulation are accepted, but the most foreign authors suggest the term «pubic articulation dysfunction» to be used. However this term also does not fully reflect the essence of the pathological process. Despite the sufficient knowledge of the problem, the management of patients with this nosology still remains a rather serious task for clinicians. The problems of the isolated using and mutual compatibility of various non-drug methods have not yet been sufficiently studied, and the use of drugs is limited by the presence of pregnancy. A case from practice is described, devoted to the isolated use (monotherapy) of osteopathic correction in a pregnant woman in order to prevent rupture of the pubic articulation.

Pregnancy management in patients with uterine fibroids. Case report

GYNECOLOGY ◽  
2021 ◽  
Vol 23 (5) ◽  
pp. 448-453
Author(s):  
Iuliia E. Dobrokhotova ◽  
Sonia Zh. Danelian ◽  
Ekaterina I. Borovkova ◽  
Elena A. Nagaitseva ◽  
Dzhamilia Kh. Sarakhova ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Uterine Fibroids ◽  
Uterine Cavity ◽  
Pain Syndrome ◽  
First Trimester ◽  
Reproductive Age ◽  
Node Degree ◽  
Birth Canal ◽  
Large Size ◽  
Natural Birth

Uterine fibroids (UF) are the most common tumor in women of reproductive age. The growth of myomatous nodes during pregnancy is non-linear and mainly occurs in the first trimester. In most cases, UF do not burden the course of pregnancy. Large size (5 cm), retroplacental location, and/or deformity of the uterine cavity by the myomatous node are associated with increased risks of spontaneous miscarriage, placental abruption, bleeding, preterm birth, and cesarean section. Myomectomy during pregnancy is undesirable, with the development of pain syndrome, the use of acetaminophen is safe. Indications for cesarean section in UF are the presence of a large size of fibroids that prevent delivery through the natural birth canal, red degeneration of myomatous nodes, torsion of the subserous myomatous node (degree 2C).

scholarly journals INTEGRATED PREPARATION OF PREGNANT WOMEN WITH A UTERINE SCAR TO VAGINAL PARTURITION

2019 ◽  
Vol 6 (1) ◽  
pp. 38-42
Author(s):  
E. P Shevtsova ◽  
Anatoly E. Miroshnikov ◽  
Yu. A Shatilova ◽  
N. A Zharkin
Keyword(s):  
Cesarean Section ◽  
Pregnant Women ◽  
Vaginal Delivery ◽  
Previous Cesarean Section ◽  
Birth Canal ◽  
Natural Birth ◽  
Uterine Scar ◽  
Previous Cesarean

Attempts of vaginal delivery in cases with a scar on the uterus after a previous cesarean section are more successful after appropriate psycho-prophylactic preparation during pregnancy. The purpose of the study is to reduce the frequency of repeated cesarean section operations. A comparison was made of the methods of delivery for pregnant women with a scar on the uterus after comprehensive training on an improved program and unprepared pregnant women. A total of 158 women were included in the study. Among them were those who had a cesarean section in history, but not trained for the current childbirth, only 5% gave birth independently. At the same time, women trained under the improved program had independent deliveries in 45.6% of cases (OR 5.813; 95% CI 0.826-40.885). The results confirm the effectiveness of the proposed improvements in the preparation of pregnant women with a scar on the uterus. The intention of such women to give birth through the natural birth canal, formed as a result of preparation, is an important factor for successfully overcoming the difficulties of the delivery process.

scholarly journals The Prognostic Value of the New Combined Hemo-Eosinophil Inflammation Index (HEI Index): A Multicenter Analysis of Anal Cancer Patients Treated with Concurrent Chemo-Radiation

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 671
Author(s):  
Margherita Rimini ◽  
Pierfrancesco Franco ◽  
Berardino De Bari ◽  
Maria Giulia Zampino ◽  
Stefano Vagge ◽  
...  
Keyword(s):  
High Risk ◽  
Cancer Patients ◽  
Anal Cancer ◽  
Prognostic Score ◽  
Univariate Analysis ◽  
External Validation ◽  
Risk Groups ◽  
Anal Squamous Cell Carcinoma ◽  
Predictors Of Response ◽  
Risk Patients

Anal squamous cell carcinoma (SCC) is a rare tumor, and bio-humoral predictors of response to chemo-radiation (CT-RT) are lacking. We developed a prognostic score system based on laboratory inflammation parameters. We investigated the correlation between baseline clinical and laboratory variables and disease-free (DFS) and overall (OS) survival in anal SCC patients treated with CT-RT in five institutions. The bio-humoral parameters of significance were included in a new scoring system, which was tested with other significant variables in a Cox’s proportional hazard model. A total of 308 patients was included. We devised a prognostic model by combining baseline hemoglobin level, SII, and eosinophil count: the Hemo-Eosinophils Inflammation (HEI) Index. We stratified patients according to the HEI index into low- and high-risk groups. Median DFS for low-risk patients was not reached, and it was found to be 79.5 months for high-risk cases (Hazard Ratio 3.22; 95% CI: 2.04–5.10; p < 0.0001). Following adjustment for clinical covariates found significant at univariate analysis, multivariate analysis confirmed the HEI index as an independent prognostic factor for DFS and OS. The HEI index was shown to be a prognostic parameter for DFS and OS in anal cancer patients treated with CT-RT. An external validation of the HEI index is mandatory for its use in clinical practice.

scholarly journals Can We Stratify Quality and Cost for Older Patients With Proximal and Midshaft Humerus Fractures?

2021 ◽  
Vol 12 ◽  
pp. 215145932199274
Author(s):  
Sanjit R. Konda ◽  
Joseph R. Johnson ◽  
Nicket Dedhia ◽  
Erin A. Kelly ◽  
Kenneth A. Egol
Keyword(s):  
High Risk ◽  
Length Of Stay ◽  
Quality Measures ◽  
Risk Groups ◽  
Hospital Quality ◽  
Minimal Risk ◽  
Middle Aged ◽  
Risk Patients ◽  
Humerus Fractures ◽  
Trauma Triage

Introduction: This study sought to investigate whether a validated trauma triage tool can stratify hospital quality measures and inpatient cost for middle-aged and geriatric trauma patients with isolated proximal and midshaft humerus fractures. Materials and Methods: Patients aged 55 and older who sustained a proximal or midshaft humerus fracture and required inpatient treatment were included. Patient demographic, comorbidity, and injury severity information was used to calculate each patient’s Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA). Based on scores, patients were stratified to create minimal, low, moderate, and high risk groups. Outcomes included length of stay, complications, operative management, ICU/SDU-level care, discharge disposition, unplanned readmission, and index admission costs. Results: Seventy-four patients with 74 humerus fractures met final inclusion criteria. Fifty-eight (78.4%) patients presented with proximal humerus and 16 (21.6%) with midshaft humerus fractures. Mean length of stay was 5.5 ± 3.4 days with a significant difference among risk groups (P = 0.029). Lower risk patients were more likely to undergo surgical management (P = 0.015) while higher risk patients required more ICU/SDU-level care (P < 0.001). Twenty-six (70.3%) minimal risk patients were discharged home compared to zero high risk patients (P = 0.001). Higher risk patients experienced higher total inpatient costs across operative and nonoperative treatment groups. Conclusion: The STTGMA tool is able to reliably predict hospital quality measures and cost outcomes that may allow hospitals and providers to improve value-based care and clinical decision-making for patients presenting with proximal and midshaft humerus fractures. Level of Evidence: Prognostic Level III.

The analysis of abdominal delivery cases at labor activity anomalies

2017 ◽  
pp. 103-106
Author(s):  
Yu.P. Vdovichenko ◽  
◽  
N.P. Goncharuk ◽  
E.Yu. Gurzhenko ◽  
◽  
...  
Keyword(s):  
Objective Assessment ◽  
Maternity Hospital ◽  
Professional Activity ◽  
Cesarean Sections ◽  
Birth Canal ◽  
Professional Management ◽  
Natural Birth ◽  
Abdominal Route ◽  
History Of ◽  
Abdominal Delivery

The objective: analysis of the frequency of cesarean sections, their structure according to the indications from the mother; study of the dynamics of the frequency of cesarean sections in case of abnormalities of labor activity (ALA) as indications for operative delivery on the basis of Kyiv City Maternity Hospital No. 1 for 2001-2011. Patients and methods. During the study, the frequency of cesarean sections in general, the frequency of urgent cesarean sections, the structure of cesarean sections according to the indications from the mother's side, the frequency of cesarean sections in ALA were studied and analyzed, and the dynamics of the cesarean section rate in ARP as well as one of the main indications with Mother's side. The history of the delivery of labor was used, which culminated in the abdominal route. Results. An increase in the level of cesarean sections was noted. The number of urgent cesarean sections is gradually decreasing. There has been a significant reduction in the incidence of cesarean sections in anomalies of labor, which are not amenable to drug treatment. Conclusion. The professional management of births, adequate justified use of medicines, the use of modern medical means in practice, an objective assessment of the obstetrical situation, cardiotocoagraphic support, timely and adequate use of epidural analgesia positively influenced the increase in the number of deliveries through the natural birth canal, which is a priority in the professional activity of the obstetrician-gynecologist. Key words: caesarian section, anomalies of labor activity.

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